Tag Archives: Resilience

The impact of cultural resiliency on traumatic loss

By Jessica Meléndez Tyler and Nancy Thacker Darrow January 12, 2023

Alexandra begins her scheduled counseling session with the news that her sister suddenly passed away the day before. The counselor is caught off guard and begins to provide supportive therapy. The counselor learns that while Alexandra’s sister had been sick for some months, her sudden health turn was unexpected and rapid. Alexandra was at the hospital when her sister died and was charged with taking the lead on making funeral arrangements.

Alexandra appears numb and detached in session. The counselor attributes this to the initial shock of the loss and provides warmth and comfort to Alexandra. In the following sessions, the counselor notices that although Alexandra appears to be functioning well following what she endorses as a traumatic loss, she demonstrates a flat affect in sessions, states she has accepted the loss and resumes work immediately although she reports feeling little connection to her current life.

The counselor is concerned that Alexandra is avoiding her grief experience, which may lead to the development of pathological symptoms. However, Alexandra reports that she is functioning just as she was before her sister’s death, only with a lost sense of purpose or spirit. She redirects therapy topics to present stress management and adjustment issues in a new career. After exploration from the counselor, Alexandra acknowledges that without her sister, she finds little point in continuing to pursue her goals as every plan was something she would share with her sister.

Cultural factors

As counselors, working with traumatic loss can be a difficult subject matter. Unfortunately, Eurocentric American society has generally promoted the avoidance of grief in subtle ways, which causes many people to be uncomfortable around people in pain. In addition, we often inadvertently provide the subtle message “it is time to move on” after a loss.

In Loss, Trauma, and Resilience: Therapeutic Work With Ambiguous Loss, Pauline Boss argued that traumatic grief — a grief “so great and unexpected that it cannot be defended against, coped with, or managed” — is significant, complex, and a diverse public and social health concern. The COVID-19 pandemic, along with a rise in social justice issues and a charged election in 2020, created difficult trials and mass grief that continues today. People experienced numerous losses at individual and community levels: loss of personal health, job security, identity, human rights security, mobility, physical safety and loved ones. Typical responses to traumatic loss may be fear, helplessness, illness, instability and even violence. As counselors, we help clients make sense of loss, redefine their lives and find meaning again. But understanding the multitude of factors needed to grieve traumatic loss is an advanced clinical skill, particularly with clients from minoritized backgrounds who have been systematically silenced.

As noted in Robert Neimeyer and colleagues’ Grief and Bereavement in Contemporary Society: Bridging Research and Practice and Darcy Harris and Tashel Bordere’s Handbook of Social Justice in Loss and Grief: Exploring Diversity, Equity, and Inclusion, cultural traditions often affect the way people respond to grief, whether that involves wearing a particular color or garment, crying or praying. Thus, understanding how trauma impacts mental health requires a broader view of identity, community, adaptation and resistance as forms of resilience. Cultural awareness, responsiveness and understanding are essential to increasing access and improving the standard of care for traumatized individuals. However, there are misconceptions about resilience encompassing an individual’s level of grit and fortitude when facing adversity. In reality, particular groups may risk developing traumatic grief because of repeated exposure to pain and suffering (e.g., the Black community, immigrants, members of the LGBTQ+ population). Also, these marginalized populations may not receive adequate treatment or community support for the causes of their grief and trauma because they may only be treated under the medical model, if they are treated at all. Taking a social justice approach, we as counselors can increase individuals’ feelings of meaning, connectedness and support following a traumatic loss. And by exploring the role and impact of cultural resiliency in navigating traumatic loss, we can consider how cultural strength can be utilized in treatment to decrease the vulnerability of disadvantaged communities.

When working with clients going through a traumatic loss, what are the perceptions we hold about the healing process? About resiliency? About treating historically harmed and excluded populations? When people and communities are overwhelmed and unsafe, they experience the world as dangerous. The rest of the world may not know about what our clients have been through, or they may have no appreciation for it. When this happens, traumatized people and communities may feel completely alone, forgotten or ignored. With traumatic loss, focusing on cultural sources for resiliency is paramount to supporting marginalized populations. This construct provides a focused way for counselors to engage with individual stories of suffering, locate causes, charge responsibility, validate the person’s struggle and activate more effective responses.

A cultural resilience approach

Utilizing resiliency soon after a traumatic event can prevent severe mental health concerns. As documented by the literature, resilience has been associated with several positive physical and mental health outcomes. However, as counselors, we must be mindful that most measures of resilience are still skewed toward Western, individualistic practices. Culture can buffer its members from the impact of trauma because it can create meaning systems and provide healing rituals where one can express their pain while remaining connected to a group. A cultural resilience approach to treating clients experiencing traumatic grief can offer a wide range of culturally responsive techniques to decrease client helplessness, hopelessness, self-blame, guilt, shame and worthlessness, especially for those with a poor clinical prognosis. In addition, a social justice approach to integrating cultural resiliency in therapy can be used to evaluate clients’ beliefs about loss, belonging, defeat, marginalization, honor and self-preservation.

Through cultural resiliency, our clients can have a pathway to express their pain in connection to their belonging group. We, as counselors, can increase our clients’ feelings of meaning, connectedness and support following a traumatic loss. We can consider how cultural strength can be utilized in treatment to decrease the vulnerability and oppression of disadvantaged and harmed communities. A social-ecological approach can incorporate cultural variables to activate resilience and acknowledge cultural components of the trauma and a client’s response.

When working with Alexandra, the case example mentioned previously, the counselor could conceptualize Alexandra’s loss from a multicultural and social justice lens, instead of focusing just on stress management. Alexandra is a Black, single, cisgender woman in her 20s who identifies as a Christian. She is in a professional role following her graduate program, and she says that she is close to her two parents and feels supported by them.

First, the counselor considers how Alexandra’s identified cultural and ethnic groups have historically demonstrated resilience. Next, the clinician asks, “How might I effectively integrate a cultural resiliency approach to my work with Alexandra?” The counselor then respectfully asks Alexandra, “What does the healing process look like within your culture as a Black person, a woman and a Christian?”

Alexandra sits and considers the counselor’s question for a minute. She then answers, “That is difficult to answer. As a Black woman, I recognize the expectation to be a strong Black woman. Emotions are a vulnerability that literally makes us less safe so we must push through no matter what. We prevail. As a woman, I also expect to take care of others before myself so my own healing will come with time, but the important thing is that my people are taken care of. As a Christian, healing looks like having faith in God and knowing that this is all a part of God’s master plan. However, I have been angry at God since my sister’s death, so I do not want to discuss faith and his master plan.”

Without identifying a client’s cultural or ethnic affiliation that guides navigating life’s circumstances, counselors may empathize personally with the client but miss the sociopolitical framework that influences the client’s traumatic loss experience. In a 2003 article published in Violence Against Women, Bonnie Burstow discussed how counseling requires both personal and political empathy to understand a client’s social location and how oppression has impacted their well-being. Society and systems are critical in clients’ trauma experiences, and a person’s group identity or identities and the historical trauma with which they are associated often underly their personal trauma history. Trauma occurs in layers, with each layer affecting every other layer.

The counselor considers Alexandra’s reply, and then says, “I hear multiple cultural influences shaping your understanding of healing. I wonder how these cultural components of healing inform your process of grieving the loss of your sister?” Alexandra sits for a moment in silence, with a thoughtful look on her face. “I feel conflicted,” Alexandra says. “I am prevailing, keeping on with my job, taking care of surviving family, and organizing my sister’s things. But I am confused and angry; everything feels unjust. How am I supposed to grieve something that should not have happened?”

The counselor validates Alexandra’s experience of injustice and her conflicted feelings. Alexandra’s question also opens the door for deeper conversations about how her cultural groups have responded to injustice and formed cultural resiliency strategies. But how can the counselor engage in the meaning-making process (the one taught in counseling programs and supervision) with Alexandra through a cultural lens?

Cultural healing and meaning making

For counselors working with clients navigating traumatic grief and loss, exploring historical and cultural healing can deepen the conversation around bereavement and mourning and aligns with our counselor identity of being strengths-based. Some of our clients come from ethnic and cultural groups that have overcome the most traumatic of trials. An intentional counselor can draw upon generations of resilience and attitudes of overcoming impossible odds despite injustices. When counselors focus only on an individual’s lived experiences without considering historical and cultural context, then beliefs about weakness, powerlessness, helplessness and worthlessness may abound because we think that we are entirely responsible for the quality of our life or lack thereof. However, when counselors explore a client’s identity and lived experience in relation to their identified groups, belief systems about belonging, strength and persistence in adversity come to the surface. In this latter scenario, healing can include considerations about how a client’s traumatic loss experience is part of a more significant social injustice that requires institutional and community remedy.

Healing involves a process of forming vulnerable narration about concepts that have been suppressed or silenced. In other words, it is important to narrate the concepts that have only been quietly discussed in the safety of within-group communities or within internal processing and self-talk. Such healing involves a therapeutic relationship of empathic witnessing and a commitment to deepening one’s understanding of the origins of the client’s pain and suffering that has often been pervasive through time and circumstance.

Returning to the example of Alexandra. If the counselor chooses to remain focused only on client functioning and symptom monitoring, they lose an opportunity to deepen the processing and healing of Alexandra’s pain that surrounds her traumatic loss. Prompting deeper reflection on the origins of Alexandra’s pain within her identities (i.e., a sister who was helpless to protect her sister from death, a Black woman who feels that she must make sure everyone else is OK before she allows herself space to grieve, and a religious woman who believes that her higher power wholly abandoned and betrayed her devoted family through this loss) can elicit more meaningful transformations in therapy. Instead of oversimplifying and focusing sessions on the pain of losing a sibling, the counselor can use deliberate Socratic questioning to probe into deeper associations of powerlessness and injustice. This exploration can help Alexandra gain the power to name her generational, historical and personal losses; feel equipped to protect herself through generational resilience; and combat alienation in her traumatic loss through cultural and ethnic identification and belonging.

Counselors can aid in this process by asking clients to tell their story of grief, not only for the immediate loss but throughout their life and previous generations. What has their identified group endured, and how pervasive are those histories in their lived experience? What and who contributes to our client’s grief story? How did they learn their expectations of what it means to suffer? By asking these questions, counselors can help grieving clients label their experiences and examine their beliefs about how their cultures factor into their feelings of traumatic loss.

The counselor decides to guide Alexandra to explore her anger with God gently. The counselor acknowledges that spirituality can be tricky to unpack because it may be perceived as unfaithful or sacrilegious to express doubts about one’s spiritual beliefs outwardly. Alexandra pauses and considers the counselor’s invitation to verbalize how her anger toward God feels. She is hesitant as she begins discussing an almost superstitious belief that if she and her family were faithful and devoted to their religious practices, they would be granted blessings and saved from the suffering others outside her religious faith might experience. She looks down, sheepish in her admission that she genuinely believes that good things happen to good people, and yet her good sister died regardless. Here, the counselor can help Alexandra not only examine her beliefs about being a strong woman of faith but also assess the intersectionality of her being a “good” woman and how that impacted her grief experience. Being a good woman means that Alexandra is outwardly stoic and strong and demonstrates resilience through continuing her responsibilities (e.g., checking in and cooking for her loved ones, managing her sister’s funeral arrangements) and by not becoming emotional around others or needing to be consoled by others.

Over several sessions, the counselor and Alexandra explore reclaiming her personal and community space. They acknowledge the outcomes of Alexandra’s labor to be resilient despite her suffering and implement rituals and ceremonies that express her grief and outrage in a way that is true to her identity as an angry woman, a betrayed woman and a woman who mourns for the generations of Black women who could not express their suffering openly and be met with warmth. The counselor then offers the client warmth and acknowledges the vulnerability it took for Alexandra to name these experiences in therapy and accept support as she not only reconnected with her historical strength and resilience as a Black woman but also rebuilt ties and traditions to being a religious woman who also historically overcame adversity.

The counselor also guides Alexandra to reconnect with nature in her grief processing, as nature has repeatedly demonstrated its resilience through catastrophic impacts. Through this, Alexandra can draw symbolic strengths and models of what resilience looks like. Her grief response changes over time; she no longer feels she must earn her right to be comforted or take up space in processing the traumatic loss. Instead, she resonates with the notion that, like in nature, she can just be and bend and transform as the circumstances require, while remaining rooted in the generations of strength and resiliency that shape her.

Through counseling, Alexandra realized that her grief of suddenly losing her sister would be ongoing and without end. However, she discovered parts of her cultural resiliency that would be beneficial to help her process this grief; using culturally resilient strategies to cope with the loss of her sister allowed Alexandra eventually to readily embrace the injustice and make meaning of the loss experience. Her bond with her sister will always remain, and her meaning-making journey will include how she continues to name and recognize how her sister shows up in her life and informs her cultural resiliency.

Often, to avoid superficial platitudes (e.g., “things happen for a reason”), individuals find themselves at a loss for words to support others going through traumatic loss. Exploring the role and impact of cultural resiliency to help clients grieve traumatic loss can metamorphize their process of bereavement and decrease counselor helplessness in the therapy room. When a horrific event occurs, we, as counselors, do not have words that will heal, and there is no cognitive reframe possible that can make a client’s suffering cease. Nevertheless, we can help clients explore their own histories of resilience and triumph in pain and adversity beyond their lived experience. This empowers a client to continue to fight to survive the unsurvivable and increases their connection and belonging with others in their identified groups and with us as the counselor.

Conclusion

Through a cultural resilience framework, counselors can guide clients through traumatic loss in a way that connects them to the dignity inherent to how their ancestors navigated and overcame suffering. An individual’s cultural groups may also hold generational pain because of oppression and abuse inflicted on the culture. Therefore, it is strongly recommended that counselors explore cultural identities with their clients and highlight helpful aspects of their identified groups that can activate resilience while leaving behind the aspects of the group the client finds unhelpful. The counselor can normalize that culture does not have to be all or nothing, and each person can write the story of how their identified groups activate and empower their group resilience.

Drawing on community connection, resources and rituals that encompass a sense of support and belonging can aid counselors and protect our clients from traumatic grief, which can lead to significant mental health concerns such as mood disorders or posttraumatic stress disorder. Learn about and emphasize the culture-based holistic strategies that clients bring into therapy. This serves to decolonize our counseling practices and enhance our current methods, while also amplifying the voices of generations who have survived and created meaning systems that can contribute to our healing through traumatic loss.

Jessica Meléndez Tyler is an associate professor of practice at Vanderbilt University and a private practitioner. She is a licensed professional counselor, a licensed counseling supervisor, a board-certified telemental health provider and a national board-certified counselor. Her professional interests include working with suicidal clients and crisis counseling, women’s issues, trauma-informed care, cultural resiliency, collegiality, and the intersection of these topics for counselor education. Contact her at jessica.tyler@vanderbilt.edu.

Nancy Thacker Darrow is an assistant professor of counseling at the University of Vermont. She specializes in grief counseling and LGBTQ+ mental health and development. Through research and practice, she aims to dismantle systemic barriers that influence these specialty areas and counselor education broadly. Contact her at nancy.thacker@uvm.edu or through her website at nancythackerdarrow.com.

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

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.

Reintegrating into a changed world amid an ongoing pandemic

By Katie Bascuas January 12, 2022

Samuel Bearer, a licensed professional counselor in St. Louis, remembers hearing a podcast interview back in fall 2020 with sociologist and author Brené Brown in which she described how the initial shock of the COVID-19 pandemic and its effects on people’s day-to-day lives had helped many individuals push through the early stages of the crisis, but after several months of pandemic living, people were starting to wear down.

“When there’s a sense of ‘I’ve been dealing with the unknowns for so long,’ there’s more and more energy it takes to maintain that level of hypervigilance,” Bearer says. “That comes at a high cost.”

At that point in the pandemic, many counselors began witnessing an increase in anxiety and depression among their clients. Some providers shifted their practice from one that had focused on supporting clients with self-actualization to one that supported clients with learning survival skills.

“You can’t self-actualize if you don’t have your basic needs met,” says Ashleigh Jackson, a licensed mental health counselor in Melbourne, Florida. “So, if there was a job loss or a partner’s job loss, money and paying bills became the priority.”

Fast-forward 12 months, and the levels of exhaustion and stress felt by many were even higher. The need for further decision-making and risk assessment turned a new corner as people started returning to work and school amid a surge in COVID-19 cases resulting from the delta variant.

As breakthrough cases mounted, dampening some of the initial excitement about the vaccine’s promise to significantly slow the virus’ spread, many people were left to wonder when or if the pandemic would end. Add to that the heated political debates around mask wearing and vaccine mandates, as well as a deluge of negative media coverage, and you get a recipe for increased levels of anxiety, depression and fatigue.

Counselors were faced with supporting clients as they navigated even more change, with added layers of uncertainty, during this reentry phase. Despite the challenges and the continued strain on many individuals — including counselors themselves — some providers began to identify opportunities for growth, both for clients and the profession.

Reassessing values around work and home

For some people, the initial reentry phase was an exciting time — a chance to return to old activities and familiar ways of life. But for others, it presented added stress for any number of reasons, including individual health concerns, the complexity of navigating a “new normal” and, for some, the realization that they were now very different from the person they had been 18 months earlier when the pandemic began.

To help clients manage some of the uncertainty around the reentry phase, Bearer says he tried to help clients see the opportunities in the transition. “The reentering is also about ‘Do I want to go back to doing what I was doing, or do I want to make a switch?’” Bearer says. “Anytime we face a crisis like that or we lose a piece of our identity, which might have been part of the work that we did — and all of that might have gone up in the air — there’s a sense of ‘Has this fundamentally changed me or not?’”

Some of those changes might include minor adjustments, such as changes in appearance or office attire. “I’ve seen several clients transition back to work and wonder, ‘Do I have to do my hair again?’” Jackson says. “But you don’t have to do these things. Those were all things that we thought that we had to do, and now we learned that we don’t.”

Some shifts that people were experiencing were more significant, however, such as deciding whether they wanted to return to working in an office setting or whether they even wanted to keep their jobs. Both Jackson and Bearer say that being a sounding board for clients to explore alternative work or employment scenarios became an important part of their work. Bearer also used the opportunity to help clients assess their values around work.

For example, Bearer found that for various clients, 18 months of teleworking had different effects on their work-life balance. Whereas some found the extra time valuable to devote to personal or family needs, others struggled with delineating their work and home lives and subsequently felt overwhelmed.

“To whatever degree that we have been affected by the pandemic, there may be moments that we come to where we can clarify for ourselves, to say, ‘Hey, if I’m feeling the tension between the value of work and the value of home, how do I clarify that for myself?’” Bearer says. “It’s normal that we fluctuate through life, but now we are learning more how to recognize which stage we’re in and what we need to prioritize.”

Bearer hopes that as more people reenter the workplace or return to pre-pandemic commitments, they get the opportunity to identify a new balance among all of their responsibilities, whether that’s at work, school, home or with family. He encourages people, where possible, to recognize this as an opportunity not to default to the broader culture, but rather to make individual choices that better resonate with their unique goals and lifestyles.

Halfpoint/Shutterstock.com

More people taking risks

In addition to decisions around work and how to return to an office or workplace, Jackson says she has noticed more clients taking large leaps of faith and making significant life changes as things began to open up more. “People are learning that life is short and everything can be gone in a moment,” she says, “so some are taking drastic risks, moving across the country, ending relationships, ending careers.”

The combination of those life changes with the physical reentry process can be a lot to manage at one time, adds Jackson, who compared the reentry phase during COVID-19 to reentering the world post-divorce or after the loss of a loved one. “We’re not the same,” she says. “But we have to figure out ‘Who am I now?’ integrating everything that’s happened, and then determine ‘How do I show up?’”

Jackson says that encouraging clients to reintegrate slowly and giving clients “permission” to not be awesome at reintegrating right away was helpful in her work with individuals feeling tension around the reentry process. She also helped to normalize clients’ fears and concerns, taught grounding and mindfulness strategies, and recommended that clients take advantage of collective resources, such as meditation and breathing apps.

Managing added stimuli

Those techniques are also helpful when dealing with the overstimulation that can come with reentry, says Emily McNeil, an LPC who owns the Mariposa Center for Infant, Child and Family Enrichment in Denver.

“Meeting all the demands of work and family and extracurriculars … it’s a trigger for a lot of depression and anxiety because people went from very low stimulation, in a lot of ways, to incredible stress and more demands, on top of the fact that we’re not out of the pandemic,” McNeil says. She incorporated a healthy dose of mindfulness, breathing and somatic techniques to help clients focus on the present moment and encourage them to take one day at a time.

McNeil and other clinicians in her practice also began referring clients to other providers, including acupuncturists, psychiatrists, massage therapists and craniosacral therapists. Given that she primarily works with children, McNeil and her colleagues also found themselves reaching out to schools more frequently. “We’ve been creating community with schools to make sure that the schools and the family and the community-based providers are all on the same page with how to support children who might be struggling,” she says. “So, our amount of case management at this time is really high.”

Not only are people being barraged with added stimuli from the physical reentry process, but many are also feeling overwhelmed with the noise coming from the media.

“It seems like we’re constantly being bombarded with breaking news and information and opinions right and left, and this can often take us out of the present space and into a pseudo reality,” says Kristin Prichard, an LPC in Houston. “Then you compound that with a novel worldwide pandemic and the restrictions and lockdowns, and it can cause our brains to go into survival mode and trigger a recurrent fight-or-flight response.”

Prichard also noticed that some clients began to create rigid opinions or reactions to try and compensate for and feel safer amid the influx of information and differing opinions. “They want to go to an extreme and say, ‘I’ve weighed it, this is my decision, and I’m not going to waiver from it,’” Prichard observes. “It’s like a protection mechanism.”

To help clients manage this type of fixed thinking, Prichard says she tries to meet clients where they are and model flexibility. “Something that I’ve tried to help individuals navigate in therapy is being more open-minded and taking in that information, but finding a way to process it before just automatically going to an answer,” she says. “[It’s about] exploring options.”

Encouraging flexibility was helpful when supporting clients as they navigated interpersonal relationships at a time when more people were gathering but not everyone was on the same page about risk and safety precautions. Prichard urged clients to have an open dialogue, as much as possible, with those they were involved with. “The best thing to move forward is to recognize that nothing is set in stone, and you really need to have open communication with others and have patience and a general level of respect,” she says.

Recognizing resilience

Despite the increase in mental health disorders and the challenges centered on navigating a new normal, another theme that many counselors noticed as the pandemic wore on was a rise in demand for therapy services. This can be interpreted as a sign of resilience, according to some providers.

“While at times it is difficult to navigate, and there are lots of challenges and setbacks as we progress and then take a step back and then progress forward, overall I’ve recognized that more people are reaching out for help,” Prichard says. “You’re seeing the resiliency of individuals and people wanting to reach out for support.”

The reentry phase provided yet another pivot point — or opportunity, depending on how you look at it — to help reframe people’s mindsets from one of discouragement and frustration to one of strength and adaptability.

“There are so many times when I’ve felt, and when I’ve heard from colleagues, clients and supervisees, that I can’t take one more thing, and then there is [one more thing], and people keep going,” McNeil says. “They figure it out.”

McNeil began using examples of people’s resilience to help validate their strengths. “A lot of people who are coming to counseling say things like ‘I’m broken,’ and I never agree with that, but this has been an opportunity for people to look within themselves and see all the things that they continued to do over the last year and a half and hold the mirror up and say, ‘Actually, you’re not broken. Look at how resilient you are even as hard as this has been. You’ve gotten through it, or at least to this point.’”

While counselors were helping clients recognize their personal resilience in the face of one more hurdle, many professionals were also recognizing their own limits and fatigue. Thus, a potential side effect, or benefit, of the pandemic’s longevity was the realization among some counselors of the need for greater personal and professional well-being to ensure effective and sustained practice.

“I’m a huge proponent and advocate for therapists having their own therapy,” says Jackson, who realized a greater need to engage in personal therapy during the pandemic. “Everyone was in crisis, as opposed to a few [clients] every week, so I had to enlist my own support to process how this was all affecting me.”

In addition to therapy, some counselors found themselves reaching out more to colleagues and others in the field who were facing similar experiences.

“I think it is really helpful to build a community of support,” McNeil says. “So, having colleagues who have your back, whether you work with them or whether they’re peers who you get coffee with or connect over Zoom with. [Having] other people who really get what you do and can share notes with you about what it’s like to work in a virtual world when we’re a relational profession.”

A new balance?

The reentry phase also presented an opportunity to assess the value of teletherapy, which became a necessity in the early stages of the pandemic but less imperative once the vaccine became widely available.

“At first I, as well as some of my colleagues, were leery of telehealth,” Prichard says. She explains that the fear of losing a sense of physical presence and connection with her clients, as well as the potential difficulty of picking up on clients’ nonverbal cues, initially made her question the effectiveness of teletherapy. However, after several months of providing virtual services to clients, Prichard says she came to respect the benefits that telehealth provides.

“What it does offer is a sense of calmness or peace for the client to know that at any time, they can check in for a therapy session from wherever they are, and they can do it in their own space, feeling comfortable, and they don’t have to deal with all the stressors and ins and outs of going into a session like traffic and parking,” Prichard says. “From that standpoint, I think it’s been a unique but rewarding thing to realize that we can provide good service care in different forms than we first recognized.”

While there are very real benefits to teletherapy, in-person therapy continues to have its benefits as well. So, what will the future delivery model for professional counselors look like? Maybe a mix of both.

“You can move forward with the new technology and a new way of doing things while still respecting other ways that you’ve done things before and finding a balance between the two,” Prichard says.

This balanced approach may also present the opportunity to serve more clients, especially if licensure portability can keep track with the technology, Jackson adds. (To learn more about the Counseling Compact effort that the American Counseling Association is supporting, visit counselingcompact.org.)

“I am encouraged that the pandemic has brought a lot of counselors to virtual,” Jackson says. “It has increased accessibility for so many people who otherwise would not get therapy, and I’m really hopeful that this will carry over into more portability for us so that we can see people in different places. We will be dealing with the effects of this for a really long time, so we need to be able to help as many people as we can in the ways that are ethical.”

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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.

What discomfort can teach you

By Shari Gootter and Tejpal June 16, 2021

Comfort is something we all seek. The notion of “being comfortable” is highly prized (and promoted) in our society. It is considered a major selling point if you are in the market to buy a bed, clothes, a car, a pair of shoes — almost anything. But the overvaluing of comfort in our lives can come at great cost.

Fizkes/Shutterstock.com

Our relationship with comfort and discomfort is influenced by our culture, our personal history and our personality. If we are born in a tradition in which failure is not an option and social success is the norm, we may challenge ourselves with long hours of work or study to avoid the discomfort of failure. If we are born into a family where depression or anger was part of the daily landscape, we may want to avoid these emotions at any price and dissociate when these feelings arise. Taking a deeper look at our relationship with comfort and discomfort provides us insight on our path toward acceptance and happiness.

Discomfort exists at many levels:

At the physical level, it may manifest as a headache, a digestive issue or a skin irritation.
At the emotional level, it may manifest as anxiety, worry or depression.
At the mental level, it may manifest as constant agitation, an inability to focus or ambivalence in decision-making.
At the heart level, it may manifest while experiencing loss, change or separation.
At the spiritual level, it may manifest as existential angst, lack of purpose or a feeling of disconnection.

Certain life events can be challenging and unfamiliar. If we are clinging to any form of comfort, we will limit our ability to adapt and grow. Through the years, the overpromotion of comfort, happiness and pleasure has created tremendous distortions. There is no tolerance for any amount of discomfort and tremendous impatience for any kind of pain. When comfort is the only choice, resilience and the ability to overcome adversity are lost.

Running from discomfort

If you want to stay centered and at peace, you need to stop running away from discomfort (or always running toward pleasure). Running from discomfort prevents us from being able to see and feel what is present. It holds us in a false state of reality and never allows us to know our true selves. On the other hand, being uncomfortable teaches us to transcend pain and pleasure, thus allowing us to be true to ourselves. It also allows us to see clearly when challenges occur.

The constant promotion of pleasure and comfort has contributed to the emergence of addictive behaviors. For example, many individuals use food, medication or gaming as a way to soothe their pain or “escape” their stress. This starts with a tremendous obsession of the mind that makes us believe there is only one way. When our mind gets frantic about one thing, there is no room for anything else and our behavior becomes extremely reactive. As soon as we grasp for more comfort, we become intoxicated. Intoxication does not necessarily have to involve a substance such as alcohol. We can be intoxicated with power or greed. As soon as we are intoxicated, we lose our intelligence and our ability to be present.

When you experience discomfort, we suggest that you stay away from labeling it, contracting and wondering when the pain will go away. None of us came to Earth to suffer, but none of us came to earth to run away from suffering either. Every time that you hit your limitations, you have the opportunity to unfold and open.

Mara, one of our clients, was struggling with tremendous discomfort. She was never satisfied with herself and experienced ongoing anxiety about her future. She dealt with her pain by consuming alcohol. After several years of doing this, Mara was no longer able to follow through with much of anything, and she ended up getting fired from her job. This was a much-needed wake-up call for Mara to realize that she needed help. When she first came to see us, she had a strong motivation to rid herself of her discomfort. But as she learned to develop a sense of compassion for herself, she grew more able to embrace her discomfort. Mara came to understand that when she was trying to cover up her discomfort, she was actually opening the door to self-destruction.

Accepting discomfort

Accepting our discomfort is led not only by bravery but by our heart center. At that moment, we choose to accept who we are. Our will does not help to heal our pain; our heart does. For Mara, getting fired was the saving grace. Others may go deeper into negative coping mechanisms that further enhance patterns of self-sabotage before determining to change their relationship with discomfort.

Often, when we experience discomfort, we perceive it as a threat. We want to separate from our discomfort to protect ourselves. When we do this, we create the opposite of what we are looking for. The more we separate from our discomfort, the more we separate from ourselves, and the more pain we experience as a result.

Underneath any discomfort, there is a fear. For some it could be the fear of missing out. For others it may be the fear of not being in control, or the fear of being overwhelmed and losing sense of self.

The longer we numb our discomfort, the more stuck we may feel. The longer we reject our discomfort, the louder our ego becomes. The practice of allowing discomfort is the practice of integration. Integration occurs when we allow our behavioral patterns, traits, emotional states and experiences to come together in a more unified and organized state. Without integration there is separation, and with separation there is distortion.

The purpose of pain is to awaken the heart, not trigger the mind. It is not about overcoming pain; it is about recognizing and being willing to learn from it.

Some spiritual traditions will bring discomfort to the core of their practice. The intent is to teach the practitioner to stay whole while in pain and to prevent the mind, led by the ego, from directing the experience. The focus is not on overcoming pain but rather on surrendering and allowing the experience of pain to expand where it wants to be. It teaches the mind not to separate but to allow. It teaches the mind to go beyond subject-object relationship. At that moment, there is an alchemy happening in the body, and one may shift from pain to bliss because the mind is not locked into form.

The practice of being uncomfortable

Regardless of your spiritual tradition and belief system, meditation is a great way to learn to be still with discomfort. Many people express difficulties when trying to learn to meditate and often give up, believing they are not good at it. The purpose of meditation is not to add pleasure or pain but rather to develop a neutral mind that allows whatever arises. Consistency in a meditation practice paves the way for acceptance and humility, which are two beautiful qualities of the heart.

If you are able to stay still during pain, without hoping for pleasure to come, you are free. If instead of fighting against the pain, you welcome it fully, you will shift and heal. When this happens, you will realize that pain and pleasure are not opposites, but simply sensations; you are now living beyond polarities.

Being uncomfortable does not always relate to pain or pleasure; our own fears and limitations can create great discomfort. To avoid discomfort, we may prevent ourselves from taking risks and put our self-development on hold. Some may feel stuck and have pushed the pause button, whereas others might operate on autopilot by staying with their to-do list. For example, some people may stay in a relationship or job even though they know it is no longer serving them. Both are forms of avoidance.

As we learn to allow pain to be part of our experience, we need to notice other possible scenarios that prevent us from learning about our discomfort. The first scenario is to be attached to our pain, allowing it to become our identity. At that moment, our life revolves around our pain, and this limits our ability to heal and make positive changes. The second scenario is to be uncomfortable with others’ discomfort. This steers us toward being “people pleasers,” constantly focusing on others’ well-being and avoiding being in touch with ourselves. Related to this second scenario, it can also be challenging to be around someone we deeply care for who is experiencing a great deal of discomfort. We may want to “fix it” or change it as a sign of love.

The practice of being uncomfortable teaches us to stay connected with ourselves, to be curious and open. It teaches us to be relaxed and surrender into the discomfort. The more we want to control our discomfort, the more stuck we become.

Allow discomfort to be part of your experience. Welcome it fully from the heart center. At the core of your pain or fear, you will grow and you will learn.

Practices

To become comfortable with the uncomfortable, we invite you to try the following practices. As with every practice, consistency and repetition are key to gaining insights and creating change.

Practicing in itself can create discomfort. It is when you are the least inclined to practice that it may be the most beneficial. Practice teaches you to go beyond your emotional reactivity. As you keep showing up for yourself, it will get easier.

Meditation Tonglen

Tonglen is a meditation practice found in Tibetan Buddhism and used to awaken compassion. Through acknowledging our own and others’ suffering, we open our hearts.

Sit in a comfortable position. Lengthen your spine and draw your shoulders down your back. Soften your face and jaw. Close your eyes.
Connect to one part of you that is in pain at a physical, emotional, mental, heart or spiritual level.
Notice the quality of your pain.
Imagine all of the people with a similar experience and inhale their pain. Do not be afraid to “inhale” others’ pain. You will not get more pain. In fact, you may feel some relief.
Exhale; send relief.
Repeat the process for at least three minutes.

Journaling

Some of you may be really reluctant to start this practice and others may simply love it. The benefits of journaling are priceless. It helps you process emotions or situations with more awareness and clarity. It is a safe container to express your voice. Research on journal writing therapy indicates positive outcomes related to identifying emotions and feelings and reducing stress. It can be a catalyst for change and healing.

Think of something that makes you uncomfortable. Is this new or old? What are the main emotions you are experiencing? What behaviors or strategies have you implemented? What did you learn about yourself?

Take action

Taking action is where the true learning takes place. You get an opportunity to truly assess your relationship with discomfort and stretch yourself.

Do something outside of your comfort zone.

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This article is based on a chapter from our book WAY TO BE – 40 Insights and Transformative Practices in The Heart of Being. For more information, go to www.40waystobe.com.

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Shari Gootter is a licensed professional counselor and certified rehabilitation counselor with decades of experience in designing and leading workshops for diverse populations. Her focus has been on helping people shift while going through losses or adjustments. She has also created programs for counselors that assist them in developing a framework that supports lasting transformation. Shari is a therapist in private practice and has taught yoga for decades. Contact her at sharigootter@comcast.net.

Tejpal has over 30 years of experience supporting individuals on their journey toward healing, life purpose and real joy. Tejpal blends her intuition, energy healing, creative processes, life coaching and yoga into her work. Tejpal was born in France and moved to the U.S. 25 years ago. She has worked with people from many cultures and traditions.

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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.

Reformulating client well-being during an economic crisis

By Scott Gleeson July 13, 2020

Various forms of the same headline say it all: “The worst unemployment rate since the Great Depression.”

The U.S. Labor Department declared back in early May that 20.5 million people had abruptly lost their jobs as many businesses shut down or significantly altered their workforce operations during the coronavirus pandemic.

For mental health counselors, the COVID-19 crisis has prompted a plethora of alterations in conjunction with health-risk anxiety — from a major uptick in telehealth services to exacerbated symptoms for clients working from home extensively for the first time in their lives.

But what about adding the loss of a job or reduced wages on top of everything else? Quarantining takes on new meaning when a career is significantly throttled. The current unemployment rate is nearly double what it was during the Great Recession of 2007-2009.

“If you think about the college graduates of 2008, they’ve been in the workforce for a decade now, and they’re experiencing another major recession,” says Clewiston Challenger, a professor of educational psychology at the University of Connecticut. “This time, there could be a longer lasting effect on the job market. Your job is a major source of identity, so therapists can play a serious role in [helping clients find] that temporary identity without work.”

Clients also may have to adjust their mental health treatments based on changing insurance coverage from a lost job, and clinicians could find themselves adjusting their rates to accommodate financial burdens.

Of course, working clients have felt emotionally compromised too.

Ingrid Erickson, a licensed professional counselor and member of the American Counseling Association, works as a career counselor for Heritage Professional Associates in Chicago and as a leadership coach for BetterUp, a training firm that helps employees and companies bolster their work fulfillment and culture. She has noticed a common trend in which still-employed clients have felt an extra emotional weight over the past several months. As such, her therapeutic approach has been adjusted into “a mini treatment plan in the context of a larger one” — a compartmentalized plan with a sharpened focus on how the coronavirus pandemic is affecting each client, and then a broader scope that contains the client’s overriding goals pre-COVID.

“A common theme is that people have been running [over] capacity,” Erickson says. “Work provides a rhythm to our lives, and for some that normalcy was taken away amidst all the uncertainty of COVID. It’s created a situation where a lot of people who are working are pretty maxed out. There’s a lot of fear, and it can be difficult constantly trying to figure out what the new normal looks like. Emotionally, cognitively, it can be really draining.

“With a lot of clients, we’ve had a mini reassessment because COVID is uniquely impacting each person in different ways, whether it’s job insecurity, high-risk loved ones, interpersonal by living in tighter quarters … It’s important to take a step back and see how the added stress is playing a role in maybe bringing a lot of things to the [emotional] surface that normal life doesn’t. I find it helpful to acknowledge how the stress affects our work life. There’s this expectation of doing our lives as normal. Well, it’s not normal right now. We’re needing patience and compassion for ourselves.”

One way that normalcy can be hindered is in clients’ bank accounts. Gideon Litherland, a licensed clinical professional counselor at Veduta Consulting in Chicago and a Ph.D. candidate at Oregon State University researching supervision effectiveness, says broaching financial concerns with clients can become necessary, even if they are avoidant of such topics.

“This is the worst economic recession since the Great Depression,” Litherland says. “We can’t ignore or not talk about what clients may very well want to ignore. If the client does not want to tend to them, what are the fears in attending to those feelings? It becomes appropriate to say, ‘Hey, things are going on economically. How is this affecting you financially?’ It is clinically relevant to check in with a client about financial stress for their mental well-being. The experiences can be ‘Where’s my next paycheck coming from? Where could I live if I get kicked out of my apartment? What happens if I declare for bankruptcy?’ It’s entirely within our role and purview as clinicians to tend to a client’s basic needs, and [financial concerns] fall under that.”

Erickson says mindsets are different for every individual based on where their career trajectory was at before the coronavirus pandemic. She adds that the past several months have greatly influenced quarter-life and midlife assessments in reverse directions based on where clients were at in their identity development.

“The market is not great right now and very unpredictable, so a lot of people who were going through a job search put actively looking on the shelf for now,” she says. “Then there might be others who almost see this breaking period, whether furloughed or laid off or working from home, as an opportunity to rethink what they want their careers to look like. There’s a freedom to really reassess with creative thinking and problem-solving. When we do career thinking on a shot clock, we don’t do our best.”

A recent Wall Street Journal report found that the worst of the coronavirus shutdowns may be over. The uptick of air travel, hotel bookings and mortgage applications could signal a turn for the better economically in the U.S. However, those improvements could be tied to temporary factors, with emergency spending from Congress among key reasons for more temporary spending.

Erickson says that looking ahead to brighter days, while necessary, can be a double-edged sword. One thing she is coaching her clients with is the premise of separating short-term goals and emotions from long-term goals and emotions.

“Long-term hope and optimism with a vision for the future can be an anchor during times of stress,” she says. “Planning for the future has a value, but at the same time, fear and anxiety for the future can paralyze, so we run the risk of getting stuck worrying and rehashing over and over to where we’re emotionally suffering based on something that hasn’t actually even happened.

“I’ve found it can be helpful to shorten the time frames to avoid the emotional flooding and just … focus on making it through the next day and week. If you’re a small business owner, instead of asking, ‘How do I help my business survive?’ then focusing on immediate issues, what’s within your immediate control and then coming back later to focus on the months ahead.”

The gradual reopening of states also means that people who were working from home will be thrust back into their old routines and structures, albeit with a renewed outlook.

“There have been a lot of positives that have come from being away from the day-to-day,” Challenger says. “For many people who see their job as their identity, perhaps this crisis gave them a chance to focus on other facets of their life and look outside of their identities as employees. And now more than ever, companies are more comfortable with distance communication, so we might see some of these industries morphing into more Zoom meetings and working from home.”

Even as some people appear set for a return to normalcy in the short term, others are likely to experience lingering impacts from the economic crisis. For instance, college graduates who were poised to enter their respective professions after earning their degrees have instead been greeted by closed doors and blocked opportunities because of the coronavirus.

“COVID happened so abruptly,” Challenger says, “and now all of the sudden companies aren’t in a position to spend money anymore. So, that job a college graduate might’ve wanted is gone.”

In the long run though, Challenger adds, “The class of 2020 will be built on resilience.”

That notion of resiliency and a bounce-back effect is where Erickson sees the silver lining.

“Resiliency isn’t built in times where it’s easy,” she says. “We’ve been forced to live our lives without resources in ways we never had before. If anything, hopefully these times can show that we can make it and shows us what we can do.”

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Related reading

See Counseling Today‘s August magazine for an in-depth feature on helping 2020 graduates navigate life after college amid the COVID-19 pandemic.

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Scott Gleeson is a licensed professional counselor at DG Counseling in Downers Grove, Illinois, and Chicago. Contact him at scottmgleeson@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.

For such a time as this: A plan of action for moving forward

By Esther Scott June 30, 2020

[Editor’s note: This is the fourth article in a series on action plans for different areas of life during the COVID-19 pandemic.]

During this period of physical distancing, a new norm of limiting touch was created. Although touches are often few and brief in American culture compared with other cultures, these brief touches contribute greatly to our emotional well-being. Many have missed the small touches of friends and family that connected them at a deeper level, or the social courtesy of a handshake during introductions.

Social distancing, although necessary, has been a big challenge. But after a period of quarantine and isolation from friends and family, perhaps a bigger challenge will be returning to normal interactions of touching one another without fear and anxiety. There are mixed emotions involved. Some people are feeling relief and gratitude as restrictions are gradually loosened, while others are experiencing frustration with the “new norm” or are fearful that others could still infect them with the virus.

Whichever side you come out on, it is important to remember that touch creates a human bond that is particularly necessary for building a healthy, more connected community. Studies show that we need to touch and be touched. Human touch is vital for well-being. It leads to the release of oxytocin, also called the “love hormone,” which helps regulate your fight-or-flight system and calms your body in times of stress.

Studies also show that lack of touch can be harmful to health. In experiments with monkeys, researcher Harry Harlow demonstrated that young monkeys deprived of touch did not grow and develop normally. We must now work at getting back to where we can touch each other without anxiety or doubt.

In the meantime, learning to express warmth and affection through words will help us move forward. Here is a plan of action for that.

Images from the United Nations COVID-19 Response page at unsplash.com

1) Focus on the future.

Every storm passes. And this too shall pass. After a period of quarantine or isolation, you may feel emotions that include relief and gratitude, or even feelings of personal growth and increased spirituality. Just as fear was once spread, hope and security can be transmitted socially too.

Looking at crises as opportunities to rethink and reorganize our priorities will prove beneficial. Crises bring opportunities for improvements that are not always possible in other conditions. The analogy of a diamond may apply here. The beauty of the diamond comes about from the extreme experience of pressure and heat. The same is true for us. We will emerge stronger from this situation and the complex challenges we have faced and are still facing. Let’s focus on a future that is filled with hope.

2) Prioritize your mental health and be flexible.

Things may get worse before they get better, but we are still here. Human beings have great capacity for adapting in times of suffering.

Prioritizing your mental health can be one of the best steps you can take at this time. For many, this will mean continuing to see their therapists or booking online sessions to talk through things and being intentional about practicing self-care.

Feeling anxious as we reintegrate as a society will be normal, but if you experience symptoms of extreme stress such as constant sleep problems or an increase in alcohol or drug use, a visit to your health care provider or mental health professional can make a positive difference. Mental health is essential to everyone’s overall health and well-being, especially during difficult times. Focus your attention on your strengths and abilities, and imagine yourself coping and adapting successfully.

Flexibility is adaptive. It is imperative that we build a foundation of healthy coping and stay connected to our values and to one another. Gratitude is a good first step toward opening the door to flexibility. In fact, the more you practice gratitude, the better your brain gets at recognizing positive things.

Start by thinking about one thing or person for which you are grateful. Focus on the feelings that arise, and hold them in your heart. Know that you can return to that thought of appreciation anytime as you move forward.

3) Be optimistic and resilient.

Optimism is the tendency to see and judge things in their most positive or favorable outcome. Resilience is our ability to overcome difficult circumstances and grow in the face of adversity. These qualities will be key in our efforts to recover. When we are anxious, we tend to overestimate and exaggerate the impact of a negative event and underestimate our chances of recovery. Resiliency gives us a realistic balance.

The ability to handle adversity will be another critical component to our success moving forward. Even if you or someone you love has been diagnosed with the coronavirus, maintaining an optimistic attitude is essential to supporting recovery. Being optimistic will help you make your thoughts and emotions much more positive, which in turn gives your immune system a boost.

The experience of the coronavirus does not have to become a traumatic and overwhelming experience that marks us for life. On the contrary, it can be an excellent opportunity to exercise our resilience — that is, to grow in the face of adversity.

Religious individuals involved in tragic circumstances often report finding peace, hope and even increased faith in the midst of the experience. Consequently, they tend to report high satisfaction in their lives. “We are hard pressed on every side, but not crushed … Struck down, but not destroyed” (2 Corinthians 4:9).

We can all benefit from this kind of optimism. Therefore, let us start filling our world with music and songs of hope in preparation for the great celebration that awaits us. We will meet again. We will celebrate again. Let’s get started.

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Esther Scott, LPC

Esther Scott is a licensed professional counselor in Arlington, Texas. She is a solution-focused therapist. Her specialties include grief, depression, teaching coping skills and couples counseling. Contact her through her website at positiveactionsinternational.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.