Tag Archives: Family

Tough love: Supporting parents of children in unhealthy relationships

By Katie Bascuas December 7, 2022

Most parents would do anything to protect their children from pain. So watching a child struggle with an addiction, whether to a substance, behavior or even a relationship, can be an excruciating experience and bring up feelings of guilt, grief, self-doubt, worry and isolation. This situation becomes trickier when the child becomes an adult because parents can no longer intervene or make decisions on behalf of their loved one. 

Most people understand the challenges that surround having a child who struggles with a substance addition, but having an adult child in an unhealthy romantic relationship or a relationship in which there may be emotional abuse, such as inappropriate use of control, disrespect or dishonesty, is often considered less “taboo” or more acceptable than a substance addiction. Most people desire the feeling of being loved and accepted, including in romantic relationships. Therefore, parents can sometimes feel helpless when they think their child may be in a toxic and painful relationship.

“I’ve got half a dozen people I’m working with right now who are dealing with this, and my encouragement to someone who has a loved one in an unhealthy relationship is that it’s going to be difficult to talk them out of it because it’s just not rational,” says Ronald Laney, a licensed professional counselor (LPC) at Change Inc. in St. Louis. “The other person is going to feel that that relationship, whatever it is, is filling a void that started long, long ago.

For counselors, supporting these parents can look similar to working with clients who have loved ones struggling with an addiction. There may be questions around how much to get involved, whether to distance themselves from their child or if they’re doing the right thing. 

And depending on the parent-child relationship, helping parents to understand and accept the situation could be challenging. For example, there may be years of unhealthy patterns of co-dependent and enabling behaviors that inadvertently perpetuate and reinforce the child’s addictive patterns, says Laura Whitcomb, an LPC who owns and operates NoCo Counseling in Fort Collins, Colorado.

“Parents are willing to do and give everything for their kids,” Whitcomb says. But “they’re often trying to control someone else’s behavior and ensure someone else’s well-being, and that person is not making those same choices.” 

Counselors can play a key role in helping parents better understand what their child may be experiencing as well as normalizing the parents’ feelings and experiences and helping them reach a place of acceptance of the situation so as to ensure their emotional and mental well-being. 

Meeting clients where they are

While it might seem like a no-brainer, Whitcomb says one of the most important things to remember when working with parents seeking support around an adult child’s unhealthy relationship is to meet those clients where they are, but she admits this can be challenging. 

“I care so much that sometimes I get ahead of myself,” Whitcomb says, noting that she has to sometimes stop herself from giving advice or providing feedback that clients may not yet be ready to hear. “I really want [the clients] to be OK. I want them to get some joy back in their lives, and I want them not to be taken advantage of and have all this responsibility that isn’t really theirs. Some of these parents should be looking toward retirement or traveling, and they’re just sacrificing everything.”  

Because counselors are trained to examine the big picture, they may recognize things that may benefit the client before the client does, notes Robin Witt, an LPC and director of relationship dynamics at the Better Institute in Pittsburgh. “My biggest piece of advice is meeting the client where they’re at and working at the pace that they feel comfortable because, especially in these trickier situations, we can see the solutions but they’re not always willing or ready to see it, and if we push it, we can lose the client,” she says. “They could get scared or intimidated, and the biggest thing that we can do for them is to be a validating, supportive resource. We might be the only person that they’re talking to about this, and … what’s most important is keeping that professional relationship safe.” 

Witt focuses on client goals and knows that change can be gradual because clients do not have control over their loved ones. And truly accepting the fact that they may not be able to change the situation to the degree that they would like often takes time. “This is not a four-sessions-and-they’re-done thing,” she explains. “So keeping a slow pace and being mindful that the client is the driver is important.” 

Whitcomb says she has to remind herself as much as her clients that she may be getting ahead of them and that the process of learning how to support and engage with a loved one in an unhealthy relationship — similar to someone with an addiction is often long and complicated. She uses frequent check-ins and asks clients what changes seem manageable to them and what they are thinking and feeling in order to gauge where they are and what they want to accomplish as well as to help them set reasonable expectations. 

Some clients, for example, may take quick or impulsive action to try and fix or ameliorate the situation, such as giving ultimatums to their loved ones, but Whitcomb says those types of actions often just push the child away and have the potential to hurt the relationship. “A lot of people seem to want to do that. They want the problem to be solved. Most of us do,” she says. “So really try and shift their focus back to themselves, less on the unhealthy person and more on them.”

Whitcomb says she draws from her experience growing up with parents who had substance use issues to help clients learn to redirect their focus to themselves. It took her several Al-Anon Family Group meetings before she realized that focusing on herself, not her parents, was one of the first steps toward healing.

“It took me four meetings before I realized, ‘Oh, these people are no longer consumed with what their addict is doing. They are focused on their own lives and rebuilding their own lives,’” she recalls. “It took me a while to get it because people are holding so much intense emotion. We’ve been hurt a lot. That lightbulb doesn’t go on just overnight.” Whitcomb says that she uses this insight to prevent herself from getting ahead of clients as well as to help explain to clients the common tendency to focus on the other person.

The importance of psychoeducation

Another helpful component of supporting parents whose adult children are in unhealthy relationships is psychoeducation, which can include accurately labeling unhealthy or abusive relationships and modeling empathy and understanding.

Witt admits there can sometimes be a fine line between educating clients and validating and supporting them. The clinician, for example, wants to acknowledge the client’s experience and how painful it may be, but they also want to help the client understand the reality of the situation, which may involve exploring uncomfortable truths such as the fact that their child is likely unaware of or unwilling to accept that they are in an unhealthy relationship and subsequently are likely in denial about the effects that the relationship is having on other family members. 

Witt finds that naming and defining abusive relationships can help clients better understand what a loved one might be experiencing. Depending on where the client is at, this can be incredibly validating in the moment, or it might be information that clients come back to in the future. “Giving them the vocabulary can be important because we might only get that client for a short time,” Witt notes. “We’re planting seeds. Someone else is watering them, and we also might be watering seeds that therapists or others have been planting and watering.” Then, if the child becomes more open to discussing their relationship or relationship dynamics down the road, the parent will be more prepared to help their child see and understand some of the unhealthy patterns taking place, she adds.

Clinicians can also teach parents the importance of meeting their child where they are, while also modeling this behavior within the therapeutic relationship, says Laura Copley, an LPC who owns and operates Aurora Counseling & Well-Being in Harrisonburg, Virginia. 

“If I was seeing a mother whose son or daughter was coming home from college and all of a sudden in this toxic or manipulative relationship, I would first need to help teach her how to slow down enough to recognize where her child is at,” she says. To do this, Copley may use open-ended questioning to encourage the mother’s exploration into her child’s mindset. For example, she may ask the client questions such as “What do you think your child is experiencing right now? How do you know your child is experiencing that? What are some of the things they’re showing you that is making you feel like this is how they’re connecting to this relationship? And if that’s the case, what might be something your child needs to hear first from you?”

Copley also advises clients to show an interest in their child’s partner by asking how that person is doing and demonstrating concern for the partner’s well-being. Clients “don’t like this part, but it works,” Copley admits, because it’s a way to show genuine concern and hopefully create a safe space where the child can open up about their own well-being without getting defensive or reactive. “The son or the daughter then starts to trust, starts to feel safe, starts to express what they’re experiencing,” she explains. Then parents can reassure their child that if something bad happens in the relationship, they can stay with them, no questions asked.

Copley says that it can also be helpful to teach parents about the positive and negative personality characteristics that are often present in someone engaging in an unhealthy relationship. For example, a person may identify as being a “savior,” so they are loyal, committed, loving and courageous. On the other hand, saviors are also prone to attracting others who “need” saving, so they may also have a fear of asking for their needs to be met or a fear of being vulnerable or getting hurt, she notes. 

“This is all part of the conversation that we could have with parents to help them understand how to bridge the mindset of where their child might be,” says Copley, who adds that she would also role-play and model various ways to approach the loved one. “How we approach another human being, even somebody like our child, around something like this will deeply influence how they receive the message.”

Setting healthy boundaries

Working with clients to set healthy boundaries is another important aspect, but it can be incredibly challenging. 

To overcome difficulties with boundary setting, Laney encourages clients to think of it as setting a boundary not only for themselves but also for their loved ones. For example, he says that parents could tell their child, “Out of my care for you, I’m going to set this boundary because it’s not doing you any good to allow you to continue to treat me in that manner.” Framing the boundary as a means of protecting the child has helped many of Laney’s clients overcome their hesitancy to set boundaries. 

Another challenge with setting boundaries, especially in the beginning, can be finding the right balance. Clients sometimes move from having no boundaries to the extreme, Laney notes. For example, a parent may go from talking to their child every day to cutting off communication completely, rather than just communicating less. “We have to find that sweet spot,” Laney says.

Therefore, it’s important for counselors to help clients understand the nuance of boundary setting as well as the feelings of guilt and anxiety that can come along with setting limits with loved ones. Witt says that she encourages clients to make values-based decisions around things such as finances, faith, career and physical well-being when setting boundaries to ensure greater success.

“Making values-based decisions leads to those boundaries that actually stick,” Witt explains. For example, a parent may value attending church every Sunday, so if their child asks them to watch their grandkids one Sunday so that they can spend time with their partner, the parent may feel more empowered to say no because it will be a values-based decision. 

“If it’s values based, [the client] is more likely to uphold the boundary versus something they feel they ‘should’ do,” Witt says. “And setting a boundary that’s not going to stick is not going to be helpful to anybody.”

Dealing with guilt, grief and shame

There’s also the possibility that parents will feel a sense of guilt while watching a child in an unhealthy relationship dynamic and wondering how their parenting style or the child’s upbringing might have contributed to the situation. 

“The reality is that … our early attachment styles can absolutely set the stage for what we expect in romantic relationships, how we expect to get treated, how we get our needs met and if that’s replicated,” Copley says. So she likes to keep clients who may be experiencing these feelings of guilt focused on the present and what they can do now as opposed to exploring past events, at least when it comes to their goal of helping their child. 

Copley refers to having clients focus on what they can do in the present as a corrective experience, one in which behaviors and dynamics from the past can be corrected in the present by making another choice and behaving differently. For example, if a parent avoided tough conversations with their child in the past because of their own discomfort around confrontation, they could decide that moving forward they will be more open to having difficult conversations with their child. 

“If there’s shame and guilt for something the [parent’s] recognizing, we can either spiral into that shame and guilt and once again make it about us,” Copley explains, “or we can say it’s a signal that another opportunity is present for you to do something different and get redemption over anything that happened in the past.” 

Copley also teaches clients how to better manage the uncomfortable feelings that their child’s relationship may be bringing up in them by using somatic techniques to decrease the chances of reacting out of fear and trying to control the situation. Often, “the storm of emotions that are more than likely in them is because they’re so afraid of what their child is going through and the pain that they must be going through,” she explains. “And if we project that fear onto someone who thinks they are in love, that’s going to push them away and make them protect the toxic person more.” 

Sometimes parents feel guilty because they were also in an unhealthy relationship when their child was growing up. Witt advises clients who are worried their child may have witnessed unhealthy relationship patterns from them to have an honest and transparent conversation with their child about it. “We can’t go backwards, but we can be mindful of what we can do today to move forward,” she notes. “Whether that’s an apology or having an age-appropriate conversation to explain ‘This is why I handled things the way I did,’ [it] can enhance the relationship that you now have with that adult child.”

To help clients work through some of the shame and guilt that they might feel in these situations, Laney says that he likes to reinforce self-compassion and will often work with clients to explore how they can accept both difficult emotions and realities. For example, he might work with clients on how to hold the sense of sadness that their child might be in an unhealthy situation with possible feelings of guilt as well as possible disappointment around the dynamics of the relationship they have with their children. 

Accepting what you can’t change 

Although it’s not easy to come to terms with potentially challenging realities, such as a child’s unhealthy relationship and its effects on the wider family, embracing a certain amount of acceptance and equanimity can be one of the healthiest solutions for these clients, Laney says. 

“At some point there’s almost a surrender,” Laney says. “We exhaust ourselves trying to change things that we really can’t change. There’s something of a letting go there.”

Whitcomb also emphasizes acceptance, especially self-acceptance, in these types of situations that often involve an element of codependence or a preoccupation over the child and the child’s relationship at the expense of parent and their well-being. “Codependence feeds on avoidance of one’s own needs and difficult emotions because by being consumed by the problems of another, we are better able to ignore and avoid encountering our own,” she explains. “As I encourage parents and family members to shift their focus from the person they are enmeshed (overinvolved) with, I also try to guide clients to identify their own strengths as well as parts of themselves they perceive as flawed.” In recognizing their strengths and taking time for self-care, clients can start to develop not only a healthier sense of confidence and independence but also more self-compassion, she says, which in turn can cultivate more compassion for others.

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Contact the counselors interviewed in this article: 

 

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Katie Bascuas is a licensed graduate professional counselor and a writer in Washington, D.C. She has written for news outlets, universities and associations.

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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.

Curfew is when?! Helping parents and teens see eye to eye on boundaries and rules

By Bethany Bray October 28, 2022

Le’Ann Solmonson, a licensed professional counselor (LPC) who owns a private practice in Nacogdoches, Texas, once worked with a teenager who was continually grounded by her parents. The client, a high school senior, was brought to counseling by her parents, who saw her rule-breaking behavior as the presenting concern.

The family was stuck in a repeating pattern where the teen would break her curfew and the parents would respond by grounding her and taking away her car and cell phone for a month to cut off all her social activities outside of school, Solmonson recalls. As soon as the punishment was lifted and the teen regained her freedom, she would immediately break her curfew, only to be grounded again.

Solmonson focused on strengthening the teen’s decision-making skills in counseling. However, she says it was equally — if not more — important to offer psychoeducation to the parents on the developmentally appropriate needs of adolescents, including social connection with peers.

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The parents did not understand that being grounded and cut off from social activities for a month is “forever” in the life of a high school senior, Solmonson says.

She worked with the parents and teen to create a plan for privilege restriction that gave the teen incentives to work toward, rather than a lengthy and complete shutoff of her freedoms. Whenever she broke curfew, the teen would be grounded without access to her car or cell phone for one week. After that, she was given access to her car to drive to school and other activities without friends as passengers. As the teen learned to respect the boundaries her parents established, she was gradually allowed to attend school football games and other events that were pivotal in the social life of a teenager.

The flexibility and freedom of this new plan further strengthened the teen’s decision-making skills on her own. In turn, the parents better understood their daughter.

Counselors are often “put in a hard spot,” Solmonson admits, because they can easily see patterns and reasons why rules and boundaries aren’t working in families where the parents and an adolescent child are at odds. For this young client, the parents’ punishments were too stringent, which curtailed any chance for the teen to learn to make better decisions on her own.

The counselor’s role, Solmonson says, is to help both parents and teens explore the factors that contribute to the child’s rule-breaking behaviors and meet in the middle to give the teen enough autonomy to mature and learn as they go.

Putting things into context

Skill building in areas such as communication, listening and distress tolerance is an essential part of counseling for teens and parents who are in conflict. Disagreements often arise over boundaries, and a key first step, Solmonson says, is to talk with parents about the importance of keeping an open dialogue with their child(ren) about the rules they set, including the context of why they’ve established them.

These conversations ensure that both parents and child have an opportunity to listen and voice their feelings even while the parents retain their rule-setting authority, Solmonson notes. She coaches parents to use phrases such as “This is the reason our family does (or doesn’t do) that,” “These are the reasons why this is the limit” or “I’ve given you my reasons and I understand that you don’t like my reasons and don’t agree, but we’re still going to do this.”

“One of the most important things parents can do is give their child a voice and make it clear that they’re open to hearing what they think,” says Solmonson, the immediate past president of the Association for Child and Adolescent Counseling, a division of the American Counseling Association.

A focus on context can also be helpful for parents who see their child’s rule breaking as the root of conflict in the home. Hayle Fisher, a licensed professional clinical counselor (LPCC) and director of adolescent services at a behavioral mental health provider in Mentor, Ohio, says she often spends time equipping parents with skills to identify what is and isn’t risky behavior. This can be especially helpful for parents whose worries are based on past experiences such as suicidality or self-harm in a child, notes Fisher, who runs her practice’s intensive outpatient program for adolescents as well as a counseling group for parents focused on navigating family challenges with teens.

For example, parents may blow up in anger when they find out that their child has used marijuana or become sexually active. A counselor can offer psychoeducation to parents that while it’s common for teenagers to experiment with substances, signs that indicate it’s a problem are when a teen is overusing a substance, using it to cope, driving under the influence, selling the drug or engaging in other illegal activity. Similarly, exploring one’s sexuality can be a normal part of adolescence, but engaging in risky behaviors such as having unprotected sex is a red flag.

Fisher uses the acronym FIDIL (sounds like “fiddle”) that she learned while in graduate school to help parents consider the full context of their child’s behavior and decide whether it’s risky. This method prompts the parent to look at:

  • F: What is the frequency of the behavior? Is it once per day, once per month, etc.?
  • I: How intense is the behavior? (For example, does self-harm involve scratching oneself or cutting to the point the child needs stitches or medical attention?)
  • D: What is the duration of the behavior? How long does the behavior last?
  • IL: What is the interference level of the behavior? How does the behavior affect the child’s functioning (daily, academic, occupational or social)?

These questions also prompt parents to think more deeply about the reasons why their child is engaging in a behavior and to identify needs the child has that are going unmet, Fisher notes. The hope is that parents will come away with increased empathy for their child and the desire to help them make behavioral changes in a supportive way.

“A lot of the time, the fight is over ‘I found cannabis in your room’ rather than the reasons why they’re using,” Fisher says. So she sometimes poses the question to the parents: “Why do they feel the need to engage in this behavior? Even if all their friends are doing it, why are they?”

Consistency is key

Consequences must be appropriate for adolescents, but they also need to be consistently enforced.

Marcy Adams Sznewajs, an LPC who counsels teenagers and young adults at the therapy practice she co-owns in Beverly Hills, Michigan, finds that parents sometimes backslide or waver on the penalties they create because they either feel the punishment was too strict or feel bad about enforcing it. Not only does this pattern send a mixed message to the child, but it also sabotages the work Sznewajs does in counseling to foster young clients’ decision-making skills.

In these cases, it may be necessary to discuss with the parents the need for clear communication and consistent expectations for their child, Sznewajs says. She explains to parents that her role is to help their child grow and build skills, and that can’t happen when situations are fixed for the child before they can learn from them.

Sznewajs once worked with a teenage boy who, upon leaving home to attend college, began to use marijuana and failed two classes in his first semester. His parents gave him an ultimatum: They would take his car away if he didn’t start passing his classes and get a job, or he would need to come back and live at home.

In his second semester, he continued to fail his classes and didn’t get a job either, so the parents took his car away. In counseling, Sznewajs prompted the client to explore his values, including his desire to get an education, and think about choices that he could make differently to re-earn his parents’ trust.

In the next session, the client reported that his parents had given his car back after one week because they felt bad that he was struggling to get to class without it. The client lost an opportunity to problem-solve, Sznewajs notes, and the parents’ inconsistency made her job “infinitely harder.”

Ultimately, she had an honest conversation with the parents about the need to be consistent with consequences for their child so that he can learn to cope with challenges.

“It’s not my job to tell a parent what to do. It’s not appropriate to point out that I don’t think they’re doing the right thing,” she says, but “having boundaries set and then discarded gives a really inconsistent message to the child and does not help them cope with difficult situations. It doesn’t help them make better decisions.” 

Is it negotiable?

When seeing an adolescent client in a session with their parents, Solmonson often finds it helpful to moderate discussions about boundaries by prompting them to create two lists: one for rules that are negotiable and one for rules that aren’t. This activity allows both parties a chance to voice their feelings, give feedback and collaborate with her in session to guide the process.

For example, the family may decide that curfew is negotiable, depending on what the teen is leaving the house for and whether it’s an organized event with a set ending time. Or parents may agree not to dictate who the teen befriends so long as they’re making good choices when they’re with those friends, and the parents will only intervene in instances when the teen makes bad choices.

Examples of nonnegotiable rules that families have agreed on include not having drugs or illegal substances in the home and never sneaking out of the house without the parents’ knowledge, Solmonson explains.

“When you find things that you can negotiate on, it gives the adolescent a sense of empowerment and a sense of control over their own life,” Solmonson says.

Seeking safety

It’s natural for children to begin to seek more autonomy as they reach adolescence, but this aspect of development often causes friction between parents and children.

For many parents, behavior that is within the family’s rules “feels safe,” whereas rule breaking can feel like a rejection of the parents, says Martina Moore, an LPCC and counselor supervisor who is president and CEO of an outpatient treatment center for co-occurring disorders in Euclid, Ohio. The heart of what sparks disagreements with children during this stage is fear.

Parents feel discomfort when they don’t have the relationship with their child that they’ve always pictured, or when the child is not fulfilling the ambitions and hopes the parents had for them. Parents often overcompensate with strict rules to try and find control, notes Moore, the president of the International Association of Marriage and Family Counselors, a division of ACA.

Moore uses these situations as an opportunity to foster discussions with parents about the vision they have for their child versus the vision the child has for themselves. She encourages parents to ask their child what they want out of life – a question that many parents have never considered before, Moore notes.

She empathizes with parents while addressing their fear directly, telling them, “What you’re afraid is that they [the child] are going down a path that derails the hopes you have for them.”

“We see the world as a scary place that can be so unforgiving that we get really fearful of what’s going to happen with our children,” she adds.

Solmonson says that she encourages parents to focus on connecting with their child despite the disagreements, frustration and discord that happen during adolescence. Putting energy and care into the relationship with their child now, when it’s difficult, may result in the child choosing to have a relationship with them later in life, when it’s optional, Solmonson explains.

She urges parents, “Don’t let the conflict destroy the relationship. Conflict is inevitable and will always happen. Take a step back, [think of the big picture] and prioritize the relationship.”

 

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Read more on how counselors can help parents and teens navigate conflict in Counseling Today’s November cover story.

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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.

When the behavior of others negatively affects clients’ mental health

By Bethany Bray June 1, 2021

In a 1624 devotion, the English poet John Donne argued, “No man is an island, entire of itself; every man is a piece of the continent, a part of the main.” 

This sentiment still rings true in modern-day counseling. Behaviors exhibited by other people in clients’ lives — often the people they love most — can affect them acutely. When these patterns are codependent, manipulative or unhealthy, it can cause clients’ presenting issues to worsen, stall their progress in counseling or otherwise negatively affect their mental health.

Examples run the gamut from an adult client whose parent deals with anxious feelings by being critical of or over-involved in the client’s life to a client whose spouse has experienced past trauma and is prone to angry outbursts.

These types of scenarios are not uncommon, and they often surface as counselors and clients begin to unpack the issue(s) that brought them into therapy, says Jen Ohlund, a licensed associate counselor (LAC) who counsels adolescents and adults at a practice in Mesa, Arizona. One indicator that a client is not getting the support they need from the people in their life can be failure to make progress in counseling, despite hard work on the part of both the client and counselor.

In counseling, a practitioner might hear clients make statements such as “I feel like I’m getting better, but I go home and I keep being told the same [unhealthy] things over and over again” or “I am doing everything I can and nothing is changing,” Ohlund says.

“Any progress they’re making is being shot down by the other individual,” she explains. “That’s when we introduce boundaries. We talk about what a healthy boundary is and equip them with [psychoeducation] that we can’t control how other people react. We can’t always walk on eggshells. Sometimes other people have to work through their triggers, and if they’re not going to do that, we have to set boundaries.”

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Seeing the whole picture

Empathic listening and validation from a counselor can serve as important first steps with clients who are wrestling with guilt, aggravation, sadness or other feelings spurred by the behavior of loved ones, Ohlund says. Simply talking through what has and hasn’t been working can be powerful, as can receiving assurance from a counselor that many people struggle with similar challenges and the client is not alone in feeling those same emotions.

“A lot of times, they don’t want to feel this way. They care and love this person,” says Ohlund, a member of the American Counseling Association. “They might feel overwhelmed [or] frustrated with their loved one or turn inward and beat themselves up, feeling like they’re not doing something right [or] not doing enough to meet [the other person’s] needs.”

Counselors can also listen for indicators that clients are struggling with isolation, a lack of boundaries (such as receiving an extremely high number of text messages from a family member) or feelings that they can “never say no” to their loved one. In these cases, clients might not have other people in their life who can act as a sounding board to give them a clear perspective. One way counselors can help clients temper the unhealthy messages they receive from a loved one is to support them in finding connection with other people who offer positivity and a voice of clarity. This will help clients self-regulate, Ohlund notes.

Michelle Fowler, an LAC at the Arizona Center for Marriage and Family Therapy, urges counselors to help these clients through an attachment lens. “We are wired to need one another and respond to one another. Doing therapy in a bubble is very unrealistic,” Fowler says. “The relationships around the client have the greatest influence on their well-being. It’s neglectful of us to ignore those contacts or not address them when they are a source of [a client’s] distress or, potentially, a resource to help in recovery.”

Asking targeted questions during the intake process is a good way for clinicians to get a picture of the supportive factors in a client’s life, says Breanna Lucci, a licensed mental health counselor at a group practice in the North Shore of Massachusetts. These questions can include:

  • Who is in your support system? Who can you turn to for support?
  • Who makes you happy?
  • What are your standards in a relationship, and how do you know a relationship is a healthy one?
  • Does your family know that you’re going to therapy, and are they supportive of that decision?
  • Describe your living environment. Is it supportive?
  • Who (other than your counselor) are you comfortable talking to about topics related to mental health?

Lucci also finds that discussions about a client’s self-talk can uncover outside factors affecting their mental health. She uses motivational interviewing with clients to delve deeper into these external influences.

For example, if a client says, “I’m anxious, but I just need to get over it,” then Lucci, an ACA member, asks, “Why do you feel that way? Where have you heard that?” Or if they say, “I’ve been told I’m stupid,” then she breaks down what “stupid” means to the client and asks, “Who said that? How did it affect you?” Talking through a client’s language choices in this way helps them to recognize patterns and realize how things they have heard from others and internalized have become part of their self-talk and self-belief. The goal of this work, Lucci stresses, is always for the client to get to these realizations on their own.

Carrie E. Collier, a licensed professional counselor who specializes in Bowen family systems theory at her Washington, D.C., practice, agrees that the language clients use in session about their relationships can relay valuable information about the client’s context and how they respond to others.

“An individual is not in a vacuum — there’s always reciprocity in relationships,” says Collier, director of the Bowen Center for the Study of the Family in Washington. “Anxiety is contagious; if a person is living with other people, there are a lot of shared emotions that are going on. I try and help a person get really clear about what’s theirs and what’s the other person’s, and what he or she is putting into it and what [others] are putting into it. … As a counselor, it’s important to see the [client’s] entire context and the landscape. It’s not just one person sitting in the office with me. It’s not a cause and effect. It’s relationships and people reacting to one another, and that is what the counselor and the client are up against.”

Fostering understanding

With those who are surrounded by unhealthy patterns, it is vital for counselors to be aware of resources (both in their local area and online) that can help clients better understand what their loved one is going through and support the client outside of counseling sessions, Lucci says.

As a licensed drug and alcohol counselor, Lucci is knowledgeable about numerous addiction resources in her area, including a recovery center that offers interventions and free family workshops. She often recommends Johann Hari’s TED Talk, titled “Everything you think you
know about addiction is wrong” (see bit.ly/3aqbpV4), to clients whose family members struggle with addiction. She also has a ready list of organizations that offer support groups and other resources to help those whose loved ones live with mental illness or who struggle with parenting issues, caregiving roles, work stress, an incarcerated loved one and a range of other challenges. The support groups and educational materials from the Depression and Bipolar Support Alliance (dbsalliance.org) and the National Alliance on Mental Illness (nami.org) can be particularly helpful, she adds.

Finding avenues of safe support outside of counseling equips this client population to “be healthy in spite of their circumstances, and some of that is [learning] acceptance,” says Fowler, who counsels adolescents, individual adults and couples. Understanding the big picture that frames a loved one’s behavior (including, in some cases, mental illness) empowers clients and can help them “gain empathy or understanding so it doesn’t feel like a personal attack,” Fowler explains. 

Roughly one-third of Fowler’s caseload is adolescents, and for these clients, questions about the adults in their life can reveal important information about the support they are — or aren’t — receiving at home, she says.

“One place that I always start, especially with the adolescents I see, is the assumption that if they could go to the adults in their circle to deal with their [presenting] problem in a supportive way, they probably wouldn’t be in my office,” says Fowler, an ACA member. “Sometimes it turns out the parents have mental health issues and the client is doing as best as can be expected. It is definitely not happening in a vacuum. … If somebody else really is why, or part of why, they are struggling, is that a person who could be involved in therapy? Is this a person who could potentially help, or does the client need coping skills to deal with [this person]? If it’s a parent and child, I definitely want the parent to come in as much as possible. But if that parent isn’t going to be a safe person because they have their own struggles or are not willing to adjust, be open and see [the] child’s perspective, then how do I shore up [the client] with coping strategies?”

One example Fowler has seen among her caseload is clients who identify as LGBTQ and “have gotten very clear messages from their family that they’re not open to talk about it.” These clients are left to work through their identity and mental health issues on their own — an experience she describes as a “personal journey of how to make peace with themselves while staying in their current environment.” 

For couples and individual clients, a dose of honesty from a counselor about how much their situation could improve may be called for, Ohlund notes. “We [counselors] don’t necessarily give advice to clients, but I also think it’s important to be clear that in some situations, if you continue to stay in this relationship, this is what it will look like. If you learn all of these coping skills and boundaries and nothing else changes, the relationship won’t be better. You can maintain the relationship and be stable, but thriving is a completely different thing,” Ohlund says. “It’s important not to be vague. Be very clear [about] what it would look like if they chose different options so they can weigh it appropriately.” 

Even as clients grow through counseling, the other person in the relationship may not change. This concept is so important, Ohlund points out, that it is written into the informed consent forms at the practice where she works.

“This is one of the most difficult parts of therapy: When you grow and develop, the people around you may not,” Ohlund says. “Once [clients] learn coping mechanisms, communication skills and begin to feel more confident … they may find that the relationships around them change, or they may not even want [those relationships] in their life” any longer.

Counselors can serve as vital resources to help these clients work through self-judgment, anger and other feelings, while equipping them with coping mechanisms such as mindfulness, self-care and self-compassion exercises, Ohlund says. She acknowledges that helping clients learn to see things through a new, healthier lens takes time. Along the way, it is important to help clients focus on the things in their life that are going well, she says.

Rewriting unhealthy patterns 

Fowler once worked with a teenage client whose presenting issues were depression, self-harm and suicidal ideation. The client’s parents had gone through a tumultuous divorce seven years prior, and her father had since remarried. The parents had 50-50 custody of the teen and continued to squabble, sometimes in front of her.

The environments at her mother’s and father’s homes were opposite. The only communication she received from her father involved correction or discipline. His home had much stricter expectations around behaviors and schedules than her mother’s home did, and the client also had stepsibling relationships to navigate at her father’s home. Because the client’s friends lived closer to her mother’s home, she had more opportunity and freedom to connect with her peers when staying with her mother.

The teen was “upside down” on whom she could trust, Fowler recalls. She was exhibiting attention-seeking behaviors online and had been hospitalized for suicidal ideation before Fowler’s work with her. 

Fowler took a different approach from the teen’s previous therapist, who had not involved the parents in the counseling sessions. Fowler focused on rewriting the parent-child and parent-to-parent communication and response patterns that had become unhealthy. She also invited the client’s mother, father and stepmother into counseling, first in a group session without the client and later with one of the adults in sessions with the client.

Fowler used emotionally focused therapy with the teen to help her learn to explain what she was feeling to her parents. The method focuses on exploring primary emotions and practicing communication of those emotions in a way that the client’s attachment figure can receive, Fowler explains. By helping the client share — and the parents truly hear what she was saying — the mother and father were better able to understand the seriousness of their daughter’s depression and the impact their discord was having on her. This experience also tapped into her father’s empathy and allowed him to put his anger aside, Fowler recalls.

Fowler also worked with the adults on how to respond to their daughter in helpful and supportive ways. “I explained that [she] is looking for support and safety and is not feeling loved or feeling approved, so she’s looking for it elsewhere,” Fowler says.

The parents agreed to stop arguing in front of the teen, and the father had a change of heart and began to plan activities to be able to spend time with his daughter in a positive way. Within months, the teen was feeling much better, and her self-harm behaviors and suicidal ideation dissipated, Fowler says. Although her parents still have to monitor her cell phone use, the client’s situation has greatly improved.

“All of that contention, seemingly overnight, went away,” Fowler says. “I know that the changes that the parents made were a huge factor in helping the child.”

It “took some convincing” for the father to change, Fowler recalls. His frustration toward his daughter stemmed from feeling that she was being unsafe online and making herself available to strange men. Ultimately, Fowler used those feelings as leverage to explain that he had a chance to be the safe man in his daughter’s life.

“That was the window that helped him see … [and] understand how he had the opportunity [to make] his daughter feel loved,” Fowler says. 

Setting boundaries

Boundary setting is one of the most important coping mechanisms a counselor can provide to clients who are surrounded by unhealthy patterns. Even though clients cannot control a loved one’s behavior, they can control the boundaries they choose to establish in the relationship, Ohlund notes. This work must be client led and will look different for each person, based on their preferences and needs.

Exploration of boundaries is best done in session when the environment is calm — before the client needs to confront a loved one in the heat of the moment. Clients should not set a boundary until they are comfortable enforcing it, Ohlund stresses. The counselor and client should also talk through what it will feel like to enforce the boundary, including understanding and preparing for the possibility that it may make the other person feel worse, including triggering anxiety or feelings of abandonment.

Sometimes people may not understand these new boundaries. “Those who benefit from not having boundaries won’t want to deal with what’s going on with them and are going to fight it a lot,” Ohlund points out.

Ohlund often works with clients to establish boundaries that have stages that are customizable if or when a situation arises. For example, if a client has a spouse or family member who is prone to critical or angry outbursts, the first step might be for the client to leave the room or go to another part of the house. If the behavior continues, the client could leave the house for a brief time. Similarly, they could choose to temporarily block the phone number of a family member who is prone to sending a barrage of text messages when that person is upset.

“This is much better than just asking them to stop. What will you do when [the behavior] doesn’t stop? We have to set a boundary that we have control over so we don’t get sucked in or pulled in,” she says. 

Ohlund once had a client whose mother did not approve of some of the ways he and his partner chose to parent their children. She would repeatedly overstep her bounds and impose her opinions on the children. The situation pitted the client’s children against him, Ohlund says.

The mother continued the behavior even though her son spoke with her about it multiple times. Eventually, with Ohlund’s support, he set a boundary that if his mother continued to disparage his parenting style to his children, he would cut off his family’s contact with her for one month.

The mother did not stop her behavior, so the client followed through and cut off contact. During that time, his mother criticized him to other members of their extended family. “He knew it was the right decision, even though it was tough,” Ohlund says. “Eventually, the mom did come around, although it took a considerable amount of time to come to that point.”

This client’s decision to hold firm to his boundary resulted in a positive outcome, but that isn’t always the case. Sometimes people don’t agree with the boundary, which can create a disconnect or distance in the relationship, Ohlund says. “The reality is that [people] don’t have control over whether someone else is going to respond or not respond. It can be very disheartening and something to grieve and think of as a loss. It’s something you are working very hard on, but it’s out of your control,” she notes.

Collier stresses that the goal of boundary setting should be to guide clients to find what’s best for their own mental health, based on their principles. It also involves reflecting on what has and hasn’t worked in the past.

“The goal is not to get the [other] person to change. That’s very important [to understand]. If you are doing something out of your own principle, then it doesn’t matter how the other person responds. You want to say it to them not because it will help them or prompt change but because it’s your principle. It will only work when the [client] has done their own principled thinking,” Collier says. She advises counselors to ask good questions and stay out of the client’s emotional process: “Don’t jump in and become involved in [a client’s] emotions. Just get them thinking about ways to do things differently.”

Lucci agrees that effective boundaries must be rooted in a client’s values. Part of this process may involve having a wider conversation on what the client’s relationship standards are, including what they want out of the relationship and what they feel is required to continue the relationship.

“Setting boundaries can be extremely uncomfortable for people, and that’s why I emphasize that [boundaries] continually change and can be adjusted,” Lucci says. “[This process] is not one session. It’s a very slow process, and it’s adjust, adjust, adjust.”

Clients who are working to establish boundaries may find it helpful to practice the necessary conversations with a counselor before initiating them with loved ones. For example, what might it feel like not to respond to a text from that person? Collier notes that a counselor can talk this scenario through with a client, acknowledge how hard it will be and assess whether it feels like the right thing to do. “Know that there is going to be an uncomfortableness; saying no is going to be hard,” Collier acknowledges. 

It may also be helpful to focus on communication techniques with these clients, including how to bring up sensitive or triggering topics with a loved one in a nondefensive way, Lucci adds. Counselors and clients can practice taking in comments and information from loved ones and then expressing themselves without spurring debate or becoming defensive. In this vein, Lucci sometimes encourages clients to write a dialogue down and read it back to her in session.

“It’s natural to get really anxious about these conversations, and a counselor can help alleviate some of that anxiety by preparing [with the client],” Lucci explains. She asks clients what the goal of the conversation is and how they want to approach it. “It’s really important to listen to what the client wants,” she says. “I want the client to feel empowered and have knowledge, but ultimately it’s their own decision” regarding how to handle the situation.

The counselor’s role

Counselors play an important role in helping clients whose mental health is negatively affected by the toxic patterns of others in their lives. These patterns may indicate that the other person needs counseling themselves, but first and foremost, the counselor’s ethical duty is to help their client, regardless of whether it is appropriate or possible to involve family members or others in their counseling sessions. (An important caveat is when counselors take measures to protect clients from “serious and foreseeable harm.” See Standard B.2.a. of the 2014 ACA Code of Ethics.)

“It’s not ever my job to diagnose someone I don’t know and those who aren’t a client of mine,” Lucci says. “But I can listen and hear the behaviors described by the client and how it’s affecting them. Then, we focus on how [the client] can deal with those behaviors. I don’t ever want to assume how someone is feeling or what’s going on. … Most of all, I want people to feel connected and come to decisions about change on their own.”

Counselors can also equip clients in these situations with resources and serve as support while they decide what they want the relationship to look like, Ohlund adds. But this work will take patience on the part of the counselor, she notes.

“As a counselor, sometimes we can see really far ahead. We can see really clearly what needs to be done in a situation, but it may take a client a very long time to get there,” Ohlund says. “Sometimes it’s easy to feel frustrated: Why can’t they see [it]? Why do they keep these patterns?” 

She advises counselors to be patient and not feel like they are doing things wrong. Instead, “be assured that you’re doing all you can to support a client, and that’s what they need — they may have never had that in their life,” she says.

Similarly, Collier feels her role is to sit with clients and ask questions to help them explore emotions and come to realizations about their situation. Her focus is on the process rather than the symptoms that bring clients into counseling. “I’m interested in how the person is thinking about the problem and the challenge, what has worked and what hasn’t worked, what they’ve tried and how they understand it,” Collier says.

Counselors also need to work through relationship struggles in their own lives to better support clients who are seeking help for similar issues, Collier stresses.

“The client’s ability to change and really think about their situation is only going to be as good as that person who is sitting in the room with them and their ability to see and think about situations,” Collier says. “Our level of maturity lends itself to what will really help a person, and that comes from really examining relationships and patterns in our own lives. That is above and beyond any technique or anything that I can do with a client. We all have problems in our own lives and our relationships, and we need to work on those so we can help clients and think objectively.”

 

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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.

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 (https://imis.counseling.org/store/catalog.aspx#)

  • “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.