Tag Archives: loneliness

Counseling Connoisseur: Counselors, pets and COVID-19

By Cheryl Fisher November 17, 2020

Isolation is the worst possible counselor.”

– Miguel de Unamuno

 

COVID-19 has provided a unique opportunity to return previously external occupations such as education and employment to the home. This is often doubly true for counselor educators and students as both classroom and clinical practice are being offered via virtual formats.

This transition has not been without challenges. Whether it is a wardrobe failure caught on camera or a feline sprawled across the keyboard, the virtual classroom and telehealth have blurred the boundaries of our privacy. Classmates, faculty and clients now have access to aspects of our home life. Virtual backgrounds may provide the appearance of an office-like environment veiling the reality of the basement, spare bedroom or even closet. However, household sounds are not as easily silenced when unmuted and meetings now often include the bark or purr of the canine or feline household member.

Additionally, the virtual world is a reminder of the distance required during this pandemic. Water cooler talk and happy hours are now hosted through chats, emails and Zoom meetings. Physical connection is relegated to those deemed safe enough to be in one’s “bubble” such as immediate family members and close friends.

Included in that bubble are the family pets. According to researcher and professor of anthropology, Brian Fagan in his book titled The Intimate Bond: How Animals Shaped Human History, “More than fifteen thousand years ago, relationships of familiarity and respect led to cooperation and companionship between people and wolves, the ancestors of the first animals to become members of human families.”

The human-animal connection has led to an interdependent relationship that has provided physical and emotional satisfaction and support for both human and other-than-human companions.

Pets motivate movement

Sitting for hours in front of the computer is contributing to Zoom fatigue and an unhealthy, sedentary lifestyle. Animals motivate movement, encourage play and promote venturing outdoors for walks. For example, my own standard poodle will indicate when it is time for my work break by staring me down. Should I not respond, she resorts to a gentle (but firm and repeated) tap on my shoulder. If I am still remiss in acquiescing her request to go outside, she will break into a barrage of vocalizations that begin as soft whines of malcontent and escalate to barks of infuriation.

One of my counselors-in training described how her pets have navigated the pandemic and motivated family walks and mutual support.

“We have two dogs, a whoodle (wheaton terrier/poodle cross) named Buffy and Coyote, a rescue, who is a terrier mix of some kind.  Buffy looks like a teddy bear and when she isn’t cuddled up with my two boys she is hunting rodents and rattlesnakes. She really lives up to the name Buffy. What can I say about Coyote? Well, he’s a chicken. He’s afraid of his own shadow. The best thing that ever happened to him is this darn pandemic because we are all at home where he can keep tabs on us.  The pandemic has forced us to spend way more time together as a family (for better or worse!) and that includes our dogs. The one thing that we started to do as a family is taking the dogs for a walk. I’m not sure why it took a pandemic to make this a family event but I’m not going to complain, and I know the dogs won’t either.”

Pets decrease symptoms of stress, anxiety and depression

The stressors that have accompanied the pandemic are numerous. Animals are also sensitive to the stress experienced by their human and strive to mediate the challenges. According to Stephanie Borns-Weil, the head of behavior service at Cummings Veterinary Medical Center, animals are also adjusting to everyone being home and trying to navigate the increase in activity. However, routine engagement with pets appears to decrease the stress hormone cortisol and decrease symptoms of anxiety and depression for both human and animal. For example, one client shared this story about her German shepherd:

“After the lockdown, I was feeling sad and isolated. He [the dog] started to see I was in bed a lot. After some time, he would pull me out of bed. Then moved me away from the couch and showing me he was getting fat as well as myself. So, the next morning, he pulled me out of bed and away from the couch. I changed my clothes and started walking. We just walked for 40 minutes, just to be outside and get some fresh air. It started for me to change my habits, diet, routine and even conversation.”

Pets provide companionship without baggage

Pets help decrease loneliness by giving and seeking companionship without the complex emotional conditions of many human relationships. This is not simply an emotional connection but a neurological bond set by increased levels of the neurotransmitter oxytocin in both humans and animals. During the pandemic, people’s increased need for companionship has resulted in an increase in the fostering and adoption of rescue animals. People are searching for that uncomplicated and fulfilling connection. For one client family the pit bull mix they rescued during the lockdown has been a calming presence and a constant companion for their children.

“She [the dog] has given the children unconditional love, a calming presence, and provided us purpose during these eight months of being at home. During the children’s ‘recess’ time from distance learning, we take her on walks around the park and play ball. She forces us to get outside to play and laugh! She keeps us in the present moment. She snuggles them, kisses them and is truly a light during darker days! We are so grateful for her companionship during these challenging times.”

For many people, pets aren’t just companions. As this story shared by a colleague demonstrates, the connection and concern we feel marks them as part of our families.

“My dog has also been my pandemic buddy, sitting next to me through Zoom calls and virtual therapy sessions. We have gone on daily walks and snuggle times on the couch as I did my notes. Sadly, during the last four months he experienced a spinal injury that got progressively worse. We’ve been working with our vet and he’s getting stronger and I can’t imagine what the long days working from home would be like without him.”

Domesticated animals and humans have a long history together. From predator and prey to companions, the relationship is both complex and primal. The pandemic has also invited a greater awareness of our coexistence with many species. Coyotes were sighted in San Francisco, bears in the streets of Los Angeles, and a peacock even adopted a London primary school and the surrounding neighborhood. Many attributed the pandemic-induced reduction in human activity to these increased sightings of wild animals in urban settings.

The human-animal connection is an interdependent relationship and one that can be especially healing during difficult times. When the time comes (and it will) when we begin to return to our classrooms and office spaces, it is important to remember that our pets will also need time to adjust to the changes. While some may be relieved by the quiet, others may be saddened to lose their daytime buddies.

However, never fear. Our pets are faithful and will let us know that deep down they will always forgive us and are ever ready for a luxurious rub behind the ears or a brisk walk in the park. Perhaps it is just as Elizabeth Marshall Thomas, one of the first Westerners to live with the Bushmen of the Kalahari desert and chronicle their relationships with animals and the author of The Hidden Life of Dogs, noted, “No person is too old or ugly or poor or disabled to win the love of a pet — they love us uncritically and without reserve.”

 

This is dedicated to my co-therapist, 12-year-old golden doodle, Max who died suddenly in July. Your friendship and guidance is sorely missed.

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Cheryl Fisher

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

 

 

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

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?

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.“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.”

“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.

Life after traumatic brain injury: Lessons from a support group

By Judy A. Schmidt October 8, 2018

Support groups are wonderful opportunities for people with similar life experiences to meet each other, share their stories and encourage one another. Group members benefit from learning coping strategies and everyday tips for dealing with various experiences. For people with traumatic brain injury (TBI), support groups offer informal opportunities for understanding a shared experience that greatly changed their lives, often within a few seconds’ or minutes’ time. They are left with physical, cognitive and emotional outcomes that impact their relationships, work and independence, often leading to loneliness and isolation.

As noted by the Brain Injury Association of America, more than 2.5 million adults and children experience a TBI in the United States each year, and support groups play a vital role in their continued recovery and re-entry to everyday life. A TBI dramatically interrupts life for these individuals and their families. Extended hospitalizations for physical recovery and long-term cognitive training for rewiring the brain alter all aspects of life, with treatment continuing for up to a year after the incident.

 

Effects of TBI

The effects of TBI are varied and highly individualized. The extent of the physical and psychosocial impacts depends on the type of injury (closed, open or acquired) and the severity of the injury. Thus, depending on the area of injury, people with TBI may deal with deficits in memory, executive functioning issues and poor judgment.

Frontal lobe injuries may lead to changes in mood and personality, difficulty making decisions and difficulty with expressive language, all of which are executive functions.

Injuries to the parietal lobe, which helps with perceptual abilities, may lead to difficulties naming words (anomia), finding words (agraphia) or reading (alexia), as well as problems with perceptual abilities that integrate sensory information. The ability to distinguish right from left may also be affected.

Damage to the temporal lobe may involve hearing loss, Wernicke’s aphasia (difficulty grasping the meaning of spoken language), problems categorizing information such as objects and short-term memory problems.

Brain injuries to the occipital lobe, which controls our vision, may lead to visual field problems, distorted perception and difficulty with reading, writing and word recognition.

Injury to the base of the skull at the site of the cerebellum creates difficulties with balance, equilibrium and coordination, as well as slurred speech.

Acute and long-term rehabilitation from TBI involves physical, occupational and speech therapy, as well as cognitive neuropsychological evaluations. As individuals recover from the physical damage, it is important for counselors to be a part of the rehabilitation team to manage adjustment to the physical injuries, acute stress and cognitive disability. In addition, the psychosocial aspects of TBI are very disruptive. They can be long-lasting as these individuals and their families begin to adapt to everyday life. Counselors are needed to provide individual and family counseling, as well as psychoeducation about TBI and recovery.

 

Psychosocial aspects of TBI

The psychosocial aspects of TBI are also related to the area of brain damage. People with frontal lobe damage may have difficulty making decisions, maintaining attention to tasks and controlling impulsive behaviors.

When the parietal lobe is damaged, difficulties occur with eye-hand coordination, reading, math and writing.

Temporal lobe damage interferes with communication skills, learning and memory. Learning difficulties due to recognition and visual field problems may result from occipital lobe damage.

In assisting people with TBI and their families, it is important to understand how psychosocial areas of life are affected and how these areas impact the potential return to daily living. For example, an individual may not return to his or her pre-injury abilities and can experience problems returning to work or school. Difficulties with problem-solving, understanding others’ emotions and social cues, or just being able to carry on a conversation may isolate the person with the TBI and increase his or her feelings of loss. Other areas of life that may be affected include the ability to drive, participate in sports and exercise, which can create deficits in the person’s social life. Problems with executive functioning can lead to challenges making sound decisions. Because safety is a major concern, the individual with a TBI may need to be monitored consistently by family, which can lead to tensions and other problems.

These are all skills that most of us take for granted or complete without much planning and forethought. But for individuals with TBI, family and personal relationships can grow strained, and the ability to build new relationships is impacted. The person’s independence and self-esteem suffer greatly.

 

Lessons learned

As a rehabilitation counselor for an acute inpatient rehabilitation program, I work with individuals who have TBIs, as well as their families, to provide counseling for stabilization, adjustment to disability and assistance with developing coping strategies. Providing support to these patients and their families as they begin realizing the extent of the brain damage and start dealing with feelings of loss is a crucial part of recovery.

For three years, I facilitated a monthly outpatient support group for people with TBI and found the experience fascinating. Hearing stories of people having car accidents, motorcycle accidents, work accidents, anoxia (deprivation of oxygen) and other unexpected accidents was difficult and often heart-wrenching. Yet these shared experiences forged a bond among group members that was undeniable and very moving.

They shared what it was like to not remember exactly what had happened to cause their brain injury. They shared what it was like to lose track of time and details and to have to trust the information told to them by health care providers, family members and friends. The fact that they each had “lost a period of time” from their lives and hadn’t been the same since seemed to build a sense of trust and caring among the group.

I soon learned that as a rehabilitation counselor, I could understand the medical, cognitive, vocational and emotional results of their injuries, but I couldn’t fully appreciate the daily psychosocial impact that their injuries had taken and continued to take on their lives.

The time since being injured varied among the support group members — anywhere from two years to 18 years. Regardless, the psychosocial effects they experienced were extensive. They talked about their school and work being interrupted, about having to settle for less challenging options or not being able to pursue their goals at all. Some shared tales of broken marriages and relationships, of losing custody of their children.

Others talked about losing their sense of independence because they had to rely on their families for almost everything. Some could no longer live at home due to the need for constant supervision, so they had to learn to live in group homes. Pursuing sports or other recreation choices was hard because of physical limitations. Another significant loss was no longer being able to drive and depending on others for transportation. The lack of money for “extras” was particularly difficult for those group members with children.

Holidays posed another challenge for these support group members because of sensory issues with noise, lights and too many people talking at once. Others discussed experiencing the stigma of having a TBI and being considered “different now” by family members and friends. This was felt particularly strongly at social gatherings, where family and friends made infrequent contact with them. Isolation and loneliness were prevalent themes in their stories. Depression, anxiety and low self-esteem made daily life a struggle.

Research conducted by Jesse Fann and colleagues in 2009 and by Annemieke Scholten and colleagues in 2016 and subsequently published in the Journal of Neurotrauma shows that the rate of depression during the first year after a TBI is 50 percent. The rate is close to 60 percent within seven years after the TBI. So, it is crucial for counselors to have this awareness of serious mental health issues in people with TBI to properly assist them and their families in seeking appropriate treatment.

Members of the support group I facilitated discussed that being on medication was difficult due to the side effects and to the cost of the medication if they had little or no insurance. They felt that cognitive retraining programs and daily psychosocial programs modeled after those for people with serious and persistent mental illness helped tremendously. The aspects of these programs that they reported helping most were receiving cognitive behavior therapy and continuing to learn more about TBI. The psychosocial programs were highly regarded because of the increase in social activities, access to vocational rehabilitation and supported employment services, and integration back into the community.

At times, the support group was difficult to manage because of the cognitive and emotional deficits with which the individuals dealt. However, the members had their unique ways of helping each other and redirecting the conversations. It was very clear that they respected one another.

Our time together as a support group transformed us into a unique family, particularly because the group remained fairly constant in its membership. The members trusted each other and understood the struggles being discussed. However, they also felt safe in correcting each other and being bluntly honest (which people with TBI are). We did have some new members join along the way. They were welcomed with open arms, and veteran members exhibited an unabashed eagerness to help. It was always interesting to hear about the creative accommodations that our members developed to live life each day and how the professionals in their lives assisted them.

As the group grew stronger, the members felt it was important for me to record what they wanted others to know about TBI and people with TBI. Their primary messages were:

  • “Conversation and expressing one’s self can be difficult.”
  • “People with TBI may not like the same things as they previously did, so don’t force us.”
  • “Tasks may take longer for people with TBI, so wait for us.”
  • “Social situations can overload people with TBI.”
  • “TBI affects everyone around the person.”
  • “Those with TBI are still the same people they were before.”

During my time with the support group, I learned many lessons. First of all, I learned that life after a TBI requires constant adjustments that must be made each day to be productive and involved. I also came to understand that time does offer healing when abundant respect and empathy are present. But most important, I learned about living life as it happens from a wonderful group of resilient individuals.

 

 

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Judy A. Schmidt is a clinical assistant professor in the clinical rehabilitation and mental health counseling program in the Department of Allied Health Sciences, and an adjunct clinical assistant professor in the Department of Physical Medicine and Rehabilitation, School of Medicine, at the University of North Carolina (UNC) at Chapel Hill. She is the rehabilitation counselor for the acute inpatient rehabilitation unit for UNC Hospital, where she provides counseling services to patients and their families after traumatic brain injury, stroke, spinal cord injury and other neurological trauma. Contact her at judy_schmidt@med.unc.edu.

 

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

The age of isolation: How Instagram memes describe a lonely generation

By Adriana V. Cornell July 26, 2018

Instagram tells millions of stories. Many exhibit our personal daily moments, and, from a wider lens, others describe entire populations and social movements. With 800 million users, Instagram is one of the biggest and richest collections of societal data on the planet. We can learn a lot by noticing what these users choose to showcase personally and which accounts and posts they choose to follow. Lately, I’ve been paying attention to the latter.

Of course, Instagram has grown since its conception, from personal accounts to brand accounts. It seems every business, school, group, dog and fetish now has an Instagram account. “Celebrities” — foodies, beauty experts, daredevils, singers, comedians and more — are born on Instagram.

In the past year, I’ve been following a few comedic accounts that display almost exclusively memes. A “meme” comes from the concept of memetic theory, championed by Richard Dawkins in his 1976 book The Selfish Gene. Just as genetics connote characteristics passed from generation to generation, memetics refer to cultural ideas transferred from person to person. A meme spreads quickly because it can reproduce itself, jumping from mind to mind and therefore driving cultural influences across the globe. According to the theory, genetics and memetics are similarly affected by Darwinian rules of evolution: Their success is subject to their contribution to the effectiveness of the person carrying them.

Memes can concern any content, but the “units of culture” I have been focusing on seem to be targeting people in their mid- to late 20s who are still navigating the transition from youth to adulthood. I’ve noticed a trend in these memes that seems both disturbing and completely normal.

Here are a few that have been featured and reproduced on multiple accounts:

 

 

 

Posts of this kind receive an immense “ovation” of likes, comments and shares. More than 250,000 people liked the first meme, and more than 14,000 commented. Most comments “at” (or link) a friend’s account, inviting him or her to view the same post, and they remark together on the accuracy and truth of the message. These comments include:

“haha, us literally.”

“Lol my life story.”

“So accurate.”

“Us every day, all day.”
“Literally EVERY f*cking time, without fail…! Millennials & bad drivers make being an agoraphobe so much easier nowadays!”

 

Most memes display simply black Arial font on a white background; they seem to rely entirely on the words that compose them. Others feature text accompanied by graphics, pictures or GIFs, such as this one:

 

But even as memes become flashier and more complex with recycled photos or videos, the rule of Darwinian evolution remains critical: The success of memes depends on the effectiveness of the person carrying them — in this case, the account holder. The popularity of a meme, evidenced in the comments section, seems to multiply if the account holder’s caption provides funny, insightful, witty commentary on the meme: in essence, a meme upon a meme.

For example, in the third meme, an account holder captioned the image with: “I’m At Lunch Not Talking To The Person I’m With, But Instead Looking At A Facebook Photo Of The Lunch Belonging To A Girl I Haven’t Seen Since […] 2007.”

This caption — using a relatable, all-too-real anecdote — brings new life and humor to a recycled post. It successfully reproduces the memetic, refueling the cultural influence and giving it new shape before it is passed on.

Users react accordingly, many of them employing the “Face with Tears of Joy” emoji as they comment specifically on the caption:

“Hahaha omg ur caption”

“the caption!!!”

“what if ur sitting with a really boring person at lunch”

“hahaha the caption tho”

 

I simultaneously find myself laughing about and relating deeply to these memes and their captions. Even if my feelings don’t agree in the moment, many of the messages tap into emotions, reactions or thoughts that I’ve certainly had. I have wished that plans would fall through. I have spent too much time scrolling through Facebook. And I have used emojis and exclamations in text that I would never say or emote in real life.

Meanwhile, I can’t help but feel disturbed by these messages and the amount of praise and endorsement they receive. They are all deeply sad and negative in tone and content because they seem to connote a total lack of feeling, social inclination and zest for life, yet at the same time, the need to be liked, included and embraced.

For this reason, I started saving memes of this kind to a “collection” — an optional, user-controlled repository for images on Instagram — that I titled “Oxymoron.” The contradiction of craving and simultaneously rejecting social interaction became an apparent theme that puzzled me. I started asking myself and lots of other (mostly 20-something) people: What’s going on here?

Some friends, while acknowledging that we’re naturally social animals, offered a simple answer. “After working a 12-hour day, that desire to socialize becomes secondary to my need for sleep,” Kelly, 28, explained. “I’m so happy if plans fall through because I feel exhausted by the idea of devoting any more energy to anything in my day.” Others echoed similar ideas and sentiments.

But this explanation didn’t seem to capture the full picture, and it seemed even my busy friends agreed. As our email exchanges developed, so did our ideas about other possible contributors to what seems like an age of isolation, neediness and sadness. After all, depression rates for teens and young adults are higher than ever (12.7 percent as of 2015, according to Psychological Medicine). The chief perpetrators, we concluded: social media and smartphones.

 

Socializing without the authentic self

Comedy is successful when it shamelessly and nakedly brings to light the truest feelings we all possess but don’t readily admit to or talk about. It can be an immensely satisfying relief to hear our private thoughts, habits and emotions exposed and articulated in an anonymous way that lets us know we’re not the only ones experiencing them — that we’re not alone.

And we will do anything to avoid feeling lonely. We will maintain friendships that we don’t enjoy. We will agree to plans that we don’t look forward to. We will stay in relationships that make us unhappy. We will join gangs, extremist groups and cults. In studying our basic human needs, Abraham Maslow determined that we will even sacrifice our safety for the sake of belonging, as evidenced, for example, by children who cling to abusive parents.

Loneliness is deadly. According to research conducted by Julianne Holt-Lunstad, professor of psychology at Brigham Young University, loneliness has the same effects on our health as smoking 15 cigarettes a day. It is more fatal than obesity.

Conveniently, smartphones have given us a tool to dismiss and evade feelings of loneliness quickly and with little effort. Texting, of course, provides the sense of company and togetherness in any and every moment. But even scrolling feeds on Facebook or Instagram can make us feel invited into the lives of friends whom we might not readily meet up with or call.

“We know that engagement with social media and our cell phones releases a chemical called dopamine,” noted Simon Sinek in a 2016 interview on Inside Quest. “That’s why when you get a text, it feels good. It’s why we text 10 friends when we’re feeling a bit lonely, a bit sad. … It’s why we count the ‘likes’ on our Instagram.” And we can do all of this without getting off the couch, without putting on fresh clothes and — best of all — without actually speaking to anyone.

Because socializing in person, face-to-face, is hard. We’re required — in real time — not only to process and listen to what others are saying, but then also to compose (witty, sensible, empathetic, affirming, interesting) comments in reply, sensitive to the situation, conversation and environment. All the while, we must align our facial expressions to the context and content, some of which changes by the second. If live conversation can be described, as it often is, as “dancing,” then texting or using social media might be described as a card game. Both require thought and strategy, but in-person communication demands spontaneity. It commands us to be our authentic selves.

But that can be complicated and challenging. What if we don’t like who we are? What if we don’t know who we are?

The pressure to be perfect has never been more intense. In his 2015 bestseller Sapiens: A Brief History of Humankind, Yuval Noah Harari wrote, “If you are a teenager today, you are a lot more likely to feel inadequate. … Even if the other guys at school are an ugly lot, you don’t measure yourself against them, but against the movie stars, athletes, and supermodels you see all day on television, Facebook and giant billboards.”

Social media allows us to craft, edit, filter and recraft ourselves so that we can come closer to this ideal. We can even consult friends before we reply to a text or post a photo, giving us the ability to depict the (airbrushed) story we wish to tell. But allowing real-time spontaneity to eventually and inevitably reveal who we really are can feel risky and terrifying.

Brené Brown boils this down to a deep aversion to vulnerability. Because we are social animals, we need to feel connected and a sense of belonging in order to survive. “Connection is why we’re here,” Brown said in her 2010 TED Talk. “It’s what gives purpose and meaning to our lives.”

And it is the fear of disconnection, Brown asserts, that often makes us feel the most challenging feelings, like vulnerability and shame.

 

A downward spiral of loneliness

The memes I have observed and collected are popular because they send the message that putting ourselves out there is not worth the risk. No one else is going out; why should you? Why let yourself feel judged, offended or not good enough?

But “for connection to happen,” Brown continues, “we have to allow ourselves to be seen. Really seen. …When we numb vulnerability, we numb joy, gratitude, happiness.” We must accept who we are and embrace vulnerability. People who are most connected, Brown found, “were willing to let go of who they thought they should be in order to be who they were. You have to do that for connection.”

The concern that has nagged me over the past year is that these memes openly reject this kind of self-exposure and authenticity, essentially instructing us to give in to our fear of vulnerability. This not only prevents others from knowing us, it prevents us from knowing ourselves. We get stuck, therefore, in a developmental stage that looks and feels a lot like adolescence — afraid of judgment, lacking self-confidence and without a sense of true belonging.

Another distinct and crucial feature of face-to-face conversation is the opportunity for touch. A pat on the back, caress on the arm, stroke of the hair or hold of the hand is essential to our mental and physical well-being. “Being touched increases the number of natural killer cells, the frontline of the immune system,” says Tiffany Field, founder of the Touch Research Institute at Miami Medical School. “Serotonin increases. That’s the body’s natural antidepressant.”

Deprivation of the sensation of touch from another human often results in feelings of isolation, social exclusion and depression. What’s more, these feelings make people fearful and put them “into a kind of defensive state where the levels of cortisol [the hormone released by the brain in times of stress] are raised,” says Kellie Payne, researcher at the Campaign to End Loneliness. “Having had negative experiences, they anticipate that their connection with people will also be negative, which makes it hard to reinstate contact.”

In short, lonely people can get trapped in a downward spiral of loneliness. These memes tap into and perpetuate this vulnerability, actively discouraging ambition, social connection and productivity.

Fortunately, our brains are resourceful; they find alternative ways to satisfy our needs. For many, this compensation is happily found in communicating via text message and social media. That dose of dopamine can be the fix we need in sad or lonely moments so that, with the approval and company of tens of thousands, we can quickly wipe them away.

Returning to Maslow, these memes, therefore, allow us to reach the two highest orders of human need: esteem (being accepted and valued by others) and self-actualization (reaching our full potential; being all we can be).

The problem is that this solution is shallow, artificial and temporary. Because although it feels like we’re raising unspoken issues of loneliness and depression, and relating to others when we like or comment on these memes, we’re not actually facing our feelings or each other, or talking about them in a way that allows us to be honest, authentic or vulnerable. At the end of the day, the humor used in these memes is merely numbing and normalizing some of our deepest and truest emotions by providing a false sense of togetherness and belonging that inevitably lets us down.

But because “connecting” to others via social media has become so easy and satisfying, like any dopamine producer, it is highly addictive. We’re no longer willing to devote energy, time and effort to our relationships (or any project) because it is —comparatively — too hard.

In other words, social media has yet to find a way to produce serotonin: a far more gratifying, long-lasting and pleasure-inducing hormone. Serotonin provides a sense of relationship, allegiance and pride after dedicating time and effort to a project or task that transcends selfish motivations. But when a meme caption says: “If you do anything interesting or important today, you can go f**k yourself,” we’re excused from trying. Instant gratification has overtaken meaningful, lasting reward, and dopamine has overtaken serotonin.

And just as any addiction — drugs, food, sex — is, by definition, extremely satisfying in the first stages, it often loses appeal, allure and thrill as it becomes more intense and demanding. The craving or desire becomes a need or chore, and we in turn become a slave to our addiction. These memes and apps such as Instagram are designed not only to “rescue” us in times of loneliness or sadness, but to draw us in constantly, at all times of day and night.

“That itch to glance at our phone is a natural reaction to apps and websites engineered to get us scrolling as frequently as possible,” wrote Bianca Bosker in a 2016 edition of The Atlantic. “In short, we’ve lost control of our relationship with technology because technology has become better at controlling us.”

When we are or feel controlled, we lose our sense of self and self-worth — our ability to produce, invent and create. The majority of Instagram users are merely consumers of information; only a small percentage of users are actually creating the message, the humor and the trend. It requires far less thought and effort to simply “at” a friend or double tap to “like” a photo than it does to lean in and think about and interact with society so that we can create our own ideas — or even just talk to one another about them.

 

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Adriana V. Cornell has spent the past two years living in Nairobi, Kenya, working as a school counselor and college counselor at an international school. She has worked primarily with high school students and has focused her writing and research on students in transition and social media. She moved back to the United States with her husband in July. Contact her at adriana.v.cornell@gmail.com.

 

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

Confronting loneliness in an age of constant connection

By Laurie Meyers December 22, 2014

In the 21st century, we have more ways to communicate and get information than ever before. News headlines and celebrity gossip reach millions of people in seconds on Twitter. We share our lives Branding-Box-Lonelywith friends and family on Facebook, post our pictures on Instagram, look for jobs on LinkedIn and share our passions on blogs and other social media outlets. When we want to talk to loved ones in far-flung locales, we no longer need to limit ourselves to the telephone — not when voice and video are just a Skype call away. But with so many ways to connect, why do we often feel so alone instead?

“One Is the Loneliest Number,” “Only the Lonely,” “Sgt. Pepper’s Lonely Hearts Club Band.” Popular culture is filled with the laments of the lonely. It has ever been thus: Loneliness is part of being human. The research on the prevalence of loneliness is mixed, but some experts believe that the number of lonely people is increasing, and some counselors report an increase in clients struggling with this issue. These professionals think that certain aspects of modern life, such as dramatic differences in the way we communicate, our overstretched schedules and our frenetic pace, can increase feelings of loneliness.

Whether or not loneliness is becoming more widespread, a 2010 AARP survey indicates that it is certainly a common issue in adults older than 45. Overall, 35 percent of survey respondents reported being lonely.

In a 2010 article in the Annals of Behavioral Medicine, “Loneliness Matters: A Theoretical and Empirical Review of Consequences and Mechanisms,” John T. Cacioppo, a psychologist who specializes in the study of loneliness, and his co-author, Louise C. Hawkley, published research indicating that loneliness is common in children and adolescents as well. Up to 80 percent of individuals younger than 18 reported feeling lonely at least sometimes.

The same study found that as many as 40 percent of those over age 65 report being lonely and that, in general, loneliness increases with advanced age. Researchers are concerned that as the population of older adults increases in the United States, loneliness will become a significant societal problem.

Psychiatrist Frieda Fromm-Reichmann is considered a pioneer in loneliness research. In her seminal article “Loneliness,” published in 1959 in Psychiatry: Journal for the Study of Interpersonal Processes, she asserted that loneliness (which she defined not as the state of being alone but rather as a lack of intimacy) played an integral role in mental health issues. She also posited that the lack of significant research into loneliness was due to people avoiding the topic because loneliness represented such a painful and frightening experience.

Since Fromm-Reichmann sounded the alarm on loneliness, however, a substantial amount of research has been conducted on the condition and its effects on the human body and psyche. It turns out that loneliness is not just emotionally painful — it can also lead to sickness and possibly even death.

As Fromm-Reichmann maintained, being alone is not the same as being lonely. The difference lies in perception. Someone can be surrounded by people yet feel totally disconnected. Conversely, a person who spends a significant amount of time alone might feel perfectly complete.

In addition, transient bouts of loneliness are not uncommon; almost everyone gets lonely from time to time. But problems arise when loneliness comes to stay. Research conducted over the past few decades has shown that chronic loneliness poses a huge health risk. In a 2010 PLOS Medicine study, researchers found that chronic loneliness is as dangerous or more dangerous than other established risks to mortality such as smoking and obesity.

The specific negative effects of loneliness on health are myriad. As Cacioppo and Hawkley noted in their Annals of Behavioral Medicine study, “Social isolation plays an important role in health and longevity, in part through its association with poor lifestyle behaviors such as lack of physical activity.”

They went on to write that loneliness can increase the risk of depression, high blood pressure, high cholesterol, cardiovascular problems, cognitive decline and Alzheimer’s disease. Loneliness also increases cortisol and systemic inflammation and causes sleep difficulties.

All of these risks are compounded by the effect of loneliness on physical activity. According to a 2009 Health Psychology study, “Loneliness Predicts Reduced Physical Activity: Cross-Sectional & Longitudinal Analyses,” loneliness in middle-aged and older adults is an independent risk factor for physical inactivity. Loneliness also increases the likelihood that people will continue to be inactive over time.

The question is, what is at the root of modern-day loneliness? A significant amount of discussion — and a growing body of research — has centered on whether the Internet and online activity might be an important factor. The answer is … maybe. It depends. A 2013 report from the National Bureau of Economic Research, “What Are We Not Doing When We’re Online?” found that online activity is partially crowding out other leisure activities. Part of most people’s online activity does include interacting with others, but on the whole, we’re probably having less real-life social contact.

However, a 2009 study in the journal CyberPsychology & Behavior, “Loneliness as the Cause and the Effect of Problematic Internet Use: The Relationship Between Internet Use and Psychological Well-Being,” found that Internet use did not have a significant effect on most people’s levels of loneliness except for with those who were already lonely.

So perhaps technology’s loneliness effect is dependent on how someone uses that technology. Still, some counselors think that technology is actually changing the way we communicate, leading to a general social disconnect that increases loneliness.

All the lonely people

“I think modern society itself can cause certain kinds of disconnection,” says Everett Painter, an American Counseling Association member and college counselor at Walters State Community College in Morristown, Tennessee. The breadth and volume of information people receive from so many different sources can be overwhelming, notes Painter, who presented a session at the 2014 ACA Conference that examined the effect that social media and technology have on personal relationships.

His view is that processing this surfeit of communication requires substantial energy — energy we might otherwise spend engaging with friends and relatives and cementing the personal bonds that allow us to feel connected. While smartphones and social media outlets allow people to communicate on multiple platforms, many of those connections are virtual rather than face to face, and not always in real time. Online activity can also eat up a substantial portion of our workdays and leisure time, which may mean time away from the important relationships in our lives, Painter notes.

“For some people, online communication can replace face-to-face communication, and I think that we need that human connection for our health,” he says.

Gerald Opthof, an ACA member and licensed professional counselor (LPC) in the Morristown, New Jersey, area, agrees. Opthof, who specializes in addiction issues but also sees couples and individuals for a variety of other reasons, says that he has noticed a significant amount of loneliness in his client base. Like Painter, Opthof believes much of the loneliness he is seeing is related to the isolation and disconnection that online communication can cause.

“With social media, smartphones, the Internet, we are more in touch with what is occurring with others,” Opthof says. “However, we are not [really] connected to individuals. We don’t sit and talk. How many times are we at a restaurant and we see people at the same table all looking at their phones?”

Socializing online just feels easier and emotionally safer for some people. However, online activity can also function as a way to hide.

“When a client engages with people via social media forums such as Facebook, Twitter, Instagram, Snapchat and others, it keeps an emotionally protective barrier in place,” says Amy Lasseter, an ACA member and LPC in Athens, Georgia.

Lasseter says that loneliness has been “popping up” more and more frequently in her practice. In some cases, she says, social media use seems to cause clients to unintentionally start the cognitive process of comparing their lives to the lives of others. “This comparison can lead to an increase in feelings of failure and reinforce emotional distance, which may lead to greater emotional isolation,” she says. “It can become a dangerous cycle.”

For certain people, social media has also turned the idea of making friends and connections into a numbers game, complete with “winners” and “losers.”

“The Internet and social media have made it possible to connect with more people, which may have increased the expectation for some people that they should be connected to more people,” observes ACA member James Huber, a licensed marriage and family therapist in Reading, Pennsylvania, and an associate professor of counseling psychology at Holy Family University in Philadelphia. This can create pressure for relationship quantity over relationship quality, and if a person’s numbers are “low,” it might lead the person to feel lonely, Huber says.

This feeling of needing to measure up can extend to other parts of life. Lasseter, for one, thinks that excessive self-expectations are becoming more common in today’s clients. “[I’m] seeing an increase in the need for perfection and the fear of failure,” she says. “These things have formed a continuum, with perfection on one end and failure on the opposite end. As a society, we’ve forgotten that our species learns by doing and that we rarely get something ‘right’ the first time.”

As with the social media “life comparisons” that Lasseter notices clients engaging in, this fear of failure and need for perfection can lead to low self-esteem and isolation, which often lead to loneliness.

Of course, social media and technology-enabled communication are not the only causes or contributors to loneliness. But all causes seem to share a unifying theme: the lack of connection.

“We are always on the run,” Opthof laments. “People are working more trying to provide for their families, and there isn’t enough time to get things done and be everywhere we have to be. This keeps us isolated.”

Opthof notes that throughout life, people go through transitions such as graduating and leaving behind their social circles, experiencing the breakup of relationships and enduring the deaths of loved ones. These transitions can fragment old relationships and require forging new connections.

Making connections

The counselors interviewed for this article agree that the principal antidote for loneliness is connection — both with oneself and with others. Research supports this. In a 2011 meta-analysis published in Personality and Social Psychology Review, Cacioppo and colleagues identified four primary intervention strategies for loneliness: improving social skills, enhancing social support, increasing opportunities for social contact and addressing maladaptive social cognition.

To encourage clients to reengage and connect, Lasseter requests that they create a bucket list containing activities they’ve enjoyed in the past as well as other activities they’d like to try for the first time. The list might include anything from traveling to taking a pottery class to learning a new language.

“I also try to help clients identify how their emotional boundaries have kept them safe in the past and how they are helping [or hurting] them now,” Lasseter says. She asks clients struggling with loneliness to identify ways that they struggle with confidence and then encourages them to push beyond their current boundaries. “The bucket list is great for this because it is filled with things they already want to do,” she notes.

Similarly, Myrtle Alvarez, an ACA member and LPC in Florence, South Carolina, suggests that clients explore groups and activities that might be enjoyable to them, noting that this could include joining a book club or church group, doing volunteer work or even just walking dogs at the local shelter.

“I encourage my clients to create a new narrative for themselves. Sometimes the things we tell ourselves become self-fulfilling prophecies,” says Alvarez, who has noticed loneliness becoming a prominent issue among clients. Rather than dwelling on their loneliness or critiquing themselves too harshly, Alvarez instructs these clients to “speak kindness and encouragement [to themselves]. Speak gain and not loss. Others will see this and, who knows, you may attract another lonely person and find healing between the two of you.”

Of course, there is no one antidote to loneliness for clients. Reaching out and connecting is a very personal process.

Huber was counseling a woman in her 30s who had recently divorced. In the process, she had lost the connection not only to her ex-husband, but also to some of their mutual friends. The client was self-aware and realized she needed to form some new relationships, but the strategy she was using wasn’t working.

“[She] was trying to meet new people and potential dating partners by going to the popular local bars,” Huber recounts. “She explained that she really didn’t like to drink, and the bar scene made her feel even more lonely.”

When Huber realized this tack wasn’t appropriate or comfortable for his client, he prescribed a different way for her to form connections organically. Huber gave her a kind of mantra that he has found to be particularly effective for clients who are struggling with feelings of loneliness: “Pursue interests, not individuals.”

“She liked singing, hiking and reading,” Huber says. “So over the next month, she joined her church choir, went on the monthly Saturday morning group hike with a local trail club and started to volunteer at a learn-to-read adult literacy program. She began to enjoy her post-divorce life more and found herself less lonely and more confident when she did meet eligible men.”

Huber believes counselors need to tailor their approaches and strategies for each individual client rather than trying to prescribe a one-size-fits-all solution for loneliness. For example, he recalls another success story with a client who was quite different from the 30-something woman who had gotten divorced. This client was “a 16-year-old popular athlete with lots of friends, but he found himself alone at home watching ESPN on weekend nights because he chose not to go to underage drinking parties or hang out with peers ‘just looking for trouble,’” Huber says. “As he put it, ‘It can be lonely doing the right thing.’ The approach with him involved affirming his decision-making and using his existing strengths to build contingency plans for weekends.”

“Since he played football, we used the concept of ‘calling an audible’” — changing the “play” — “when he needed to find meaningful options when friends were engaged in undesirable activities,” Huber says. “He felt connected to others [when doing] service projects, so he began to participate in a program that involved visiting older adults, to walk the neighbor’s dog or to referee basketball at a local youth center when he needed alternative social connections.”

Huber says counselors might also consider using other techniques he has found useful for clients dealing with loneliness:

  • Reframe loneliness from being a “sign of a problem” to a “signal to change.” Huber validates the client’s feelings of loneliness but also encourages the client to use those feelings as the impetus to practice and utilize the skills he or she has learned in counseling rather than just giving up.
  • Focus on the client’s strengths, interests and efforts early and often. Huber discusses the client’s feelings of loneliness but expands the discussion with a verbal and written inventory of the person’s strengths and interests. Huber asks the client to consider scenarios in which he or she might potentially develop or may already have connections. These scenarios include groups and environments such as work, school, recreation networks and religious communities.
  • Describe therapy as an opportunity to practice relationship-building skills. “Practicing relationship skills in session involves identification, preparation and rehearsal of relevant skills in therapeutic role-playing,” Huber says. “For example, if the client is learning to initiate and maintain small talk when meeting new people, then we practice using these skills in a variety of typical social situations.” During these role-play scenarios, Huber and the client discuss behaviors that help people connect, such as showing interest, expressing care and respecting others. 
  • Explore the “loneliness paradox”: Not everyone who is alone is lonely; not everyone who is lonely is alone. Huber and the client dissect the paradox by discussing the difference between being alone and being lonely.
  • Define elements of “healthy solitude” versus default loneliness. “Healthy solitude is the choice to occasionally be alone [and] nourish mind, body and spirit,” Huber explains. “Loneliness is a feeling of being separated, isolated or disconnected from others without a choice.”
  • Shift the focus of treatment away from chronic feelings of loneliness and toward cognitive choices. In other words, work with the client on changing maladaptive thinking that can perpetuate loneliness by shifting the client’s perception of self and others. Huber helps shift the client’s negative perception of self by targeting automatic negative thoughts such as “It’s no use trying” or “Nobody would want to be with me.” He and the client work together to edit these habitual thoughts to instead create a mindset conducive to overcoming loneliness. For example, instead of dwelling on all-or-nothing or self-limiting thinking, Huber encourages clients to make statements such as “I could try several things to meet more people; some might work, some may not” or “I have some qualities that people may enjoy.”
  • Teach clients to rehearse and follow the three-step ACT mantra when they are feeling lonely:

Adjust your attitude. Instead of thinking, “Nothing will help,” try “Something may help with practice.”

Cultivate a connection: “Reach out to at least one person for support when practicing new skills,” Huber urges his clients. “You don’t have to go it alone.”

Try something tangible: “Analysis can lead to paralysis,” Huber says. “Instead of wondering about going to a cooking class, go to a class. Instead of thinking about calling a classmate, make the call. Instead of hoping you will be invited to dinner, invite someone for a meal.”

Opthof uses rational emotive behavior therapy and cognitive behavior therapy to help clients struggling with loneliness to reframe. He works with clients to get them to rethink their situations and look at them from a more rational view. He also encourages clients to confront their loneliness by engaging in other pursuits. Opthof enhances this work by encouraging clients to consider pursuing a whole-person, mind-body approach.

“I often spend a session with them discussing their diet, making sure they are eating as healthily as possible and encouraging them to get moderate exercise such as just taking a walk around the block,” he says. “I also recommend they look into yoga or meditation.”

Opthof also encourages clients to cut back on activities that distract and isolate. “The major tip that I give my patients is to cut back on the disconnection items — turn the phone off 30 minutes before going to bed, shut the phone off in the car, read email only a few times a day,” he says. “I encourage my patients, lonely or not, to focus on the here and now, [to] be in the moment. Often clients report that they feel less lonely when they try a few simple steps.”

Addressing loneliness also requires clients to foster a connection with themselves, says Marie Holland, an ACA member and LPC in Nags Head, North Carolina. She helps clients to increase their self-understanding by being mindful of their emotions. Holland also encourages the therapeutic relationship through validation. She lets clients know they are being heard by asking them questions and making it clear that she is open to whatever they have to say.

Holland has found group therapy helpful for uncovering and exploring self-esteem issues with clients. Often, low self-esteem can be at the root of an individual’s isolation and feelings of loneliness. In group, she says, clients feel safe revealing esteem issues because they are surrounded by people struggling with the same problems. Therefore, they feel less likely to be judged.

Holland also addresses clients’ negative self-image by helping them examine the self-judgments they make. She also guides them away from focusing on thoughts and encourages them to be aware of what they are feeling through mindfulness and meditation. In addition, Holland uses progressive muscle relaxation and guided imagery with clients.

Holland also uses an active approach to help clients combat loneliness. “The practice of role-playing with assertive communication skills is extremely helpful because it allows for the individual to experience success and gain confidence in their new skills,” she says.

Finding community

Although relying solely on technological sources for a social life can be harmful, clients can use online tools — particularly social media — to make new connections and strengthen old bonds.

People may even be expanding their social networks through social media by finding old classmates and long-lost friends. A 2011 Pew Research survey on social media found that Facebook users are more likely to have a larger number of close social ties. With that survey population, at least, Facebook seemed to encourage the development of intimate personal ties. The survey also found that people are increasingly using social media to keep up with their close friends; 40 percent of users have “friended” their core confidants.

Although it’s true that social media can be used to maintain or even enhance a person’s circle of friends, Opthof, for one, thinks people need to regularly get offline and make it a priority to interact with the people around them. Community is an important source of connection — one he feels we too often ignore in today’s society.

“When I walk around my neighborhood, there’s no one sitting on the front stoop or porch. We’ve gotten away from that. Now we all have decks,” he laments.

Opthof says he once enjoyed waving to people as he walked around, but now there’s nobody to wave to. All his neighbors are inside or behind the backyard fence — on their decks.

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To contact the individuals interviewed for this article, email:

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

Letters to the editor: ct@counseling.org