Tag Archives: Self-care

Primum cura te ipsum: First, heal thyself

By Samuel Kohlenberg August 17, 2020

During this bizarre and painful epoch beset by pandemic, racial trauma and social injustice, there is a growing emphasis on clinician well-being and self-care, and rightfully so.

Countless articles and blogs have been written about self-care for counselor clinicians, and here is one more. Why write another one? Because as a counselor educator and supervisor, I want to sell you on a goal other than being OK enough to work. Because avoiding burnout is not enough. We need to set the bar higher to competently render care. Make no mistake, this is an ethical issue.

Like many, perhaps, I have always found Latin venerating in a way that underscores the importance of a phrase or idea. Whether carved into cornerstones or encircling university seals, the tradition has gravitas. One idea I find worthy of such reverence, as it pertains to psychotherapy and behavioral health, is that clinicians need to “do their own work.” Therapists need to heal.

Whether it is through traditional talk therapy or other means, therapists need to attend to their own trauma, developmental journeys and growth. While the oft-cited phrase attributed to Hippocrates, “primum non nocere” (first, do no harm), is a vitally important doctrine in mental health, I am suggesting that there is an overlooked and more sequentially vital step in terms of primacy required to avoid doing harm: that therapists confront and deal with their own issues.

Although therapists are often told that they need to take care of themselves and “do their own work,” I do not believe there is enough understanding regarding why this is so crucially important. Yes, it benefits the therapists, it may mitigate burnout, and it may increase professionals’ longevity in the field. But from my perspective, not enough emphasis has been placed on the idea that people who are not OK do not make competent therapists.

This is not to say that people who have endured trauma or have previously met criteria for a behavioral health diagnosis should not pursue jobs as therapists. Far from it. Many of the best therapists I know are as good as they are in large part because of the difficult roads they have had to walk.

There are many ways to describe how therapists doing their own work might affect them professionally, but I am going to focus on three ideas:

1) Your nervous system is an instrument for attachment work and relationship, and it is shaped by how much work you have done.

2) Doing your work helps you project less and become more aware of your projections.

3) Having done the work means being able to genuinely relate to what your patients are going through instead of just understanding. (Note: Although I say “patient,” please feel free to substitute “client.” The reason I prefer patient is that I feel it better emphasizes the connection between the physical and psychological realms, and given the field’s current understanding of the interconnection between the two, I intentionally use language that fits in both lexicons.)

The nervous system

In a typical stress response, a perceived threat can activate the amygdala, leading to the release of epinephrine and coordinating a sympathetic response to the stressor. Typically, this sort of sympathetic activation means that you are no longer using the circuits associated with optimal social engagement (consider, is it harder to tell how other people feel when you are angry?).

The social engagement system is characterized by the feeling of social connection, the ability to read social cues, eye contact, voice modulation and comfort. All of these things shut down when we go into sympathetic activation as part of a stress response.

Imagine a therapist who has yet to “do their own work” sitting in their office listening to their patient describe a traumatic event. Even if an activated therapist gives no obvious facial expression or gesture, how do you think the person sitting across from them will be affected by the therapist’s nervous system switching gears from social engagement to fight-or-flight?

Imagine for a moment a scared child running to a parent or caregiver and being met with warm eyes, a soft smile and a soothing voice. Now imagine the same child being met with scared eyes, decreased facial muscle tone and a flat voice. In which situation is the child going to be more OK?

Similar dynamics play out in therapy. This means that therapists’ ability to stay in their social engagement system affects patients’ likelihood of being OK while doing things such as trauma work. Part of a therapist’s work is using their nervous system to help resource a patient’s nervous system. For some, it will take significant and ongoing work to be able to do this well. 

Awareness

Awareness and projection share a simple relationship: The more aware you are of your projections, the less likely you are to inadvertently allow those projections to affect your relationships with others.

Regardless of theoretical underpinning, modality or clinical philosophy, virtually all types of psychotherapeutic work regard the relationship between therapist and patient as instrumental. Thus, if the therapeutic relationship itself is one of the primary means by which therapists ply their trade, and a lack of awareness can lead to one’s projections interfering with relationships with others, there is an argument to be made that therapists are on ethically dubious ground if they practice without having cultivated enough awareness and done enough work to overcome this potential pitfall.

You are missing your patient if all you can see is your projection. You are not going to realize that it is a projection if you have yet to cultivate enough awareness. 

Relating

There is a difference between understanding what someone is going through and being able to truly relate to it. While psychotherapists are undoubtedly an empathetic bunch, helping someone engage in the process of developmental therapeutic growth beyond where you yourself have grown is no easy task.

Imagine for a moment a 40-year-old in the midst of an existential crisis. Now imagine an empathetic and well-meaning 14-year-old attempting to help that 40-year-old. Unfortunately, a developmental stage is not always as clear as chronological age, and this can lead to blind spots for clinicians that may negatively affect quality of care. Being able to genuinely relate to what your patients are going through is important, and the 14-year-old is going to have a heck of a time helping the 40-year-old.

Keep doing your work

The thing that all of the above ideas boil down to is relationship. It is your job to ensure a helpful clinical relationship, and the relationship itself is the greatest clinical tool that you have. Ensuring that this primary tool is going to be functional, let alone optimal, can require time, effort and a willingness to endure the discomfort necessary for growth.

Of course, more basic day-to-day self-care is still important for fighting burnout and for resourcing one’s self, especially when you are tasked with taking care of others and especially during times in which nobody seems to be OK. The invitation, the challenge, the mandate, is to not stop at “resourced.”

Aim higher. Embrace catalysts for growth and development. Get comfortable with discomfort when it means a potential breakthrough. Do it for you. Do it for them. Do it like it’s your job.

 

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Samuel Kohlenberg is a clinical psychophysiologist, licensed professional counselor and behavioral health educator specializing in the treatment of stress. He is a master of education in the health professions fellow at Johns Hopkins University and a postdoctoral fellow at Saybrook University and works in private practice in Denver. Contact him through his Facebook page or through his website at denverstressclinic.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.

The revised meaning of self-care in the wake of COVID-19

By Scott Gleeson August 4, 2020

Practicing proper self-care is often the prescription that professional counselors will share with their clients to help manage life stressors and mental health symptoms during their day-to-day lives.

That emphasis has taken on new meaning over the past several months as self-care routines have been offset by quarantining measures from the COVID-19 pandemic. Suddenly, sleeping patterns were thrown off by newfound anxiety. Routine pleasures such as listening to a podcast or playlist during the morning and evening commute disappeared as working from home became the new norm. With gyms closed, people were forced to adjust their exercise routines and workout habits. Typical avenues of social escape — restaurants, movie theaters, salons — were also closed. Even parks and hikes were off-limits in some states for a time.

In spite of the limitations, self-care has never been more meaningful given the conditions that people found (and, in some cases, still find) themselves in. Stephanie Burns, an associate psychology education professor and coordinator of the clinical mental health counseling program at Western Michigan University, says the unprecedented times prompted unprecedented human responses.

“Two things were happening at once for clients coming into therapy: They were going through their own already-existing struggles of depression and anxiety. Then there’s the trauma from what this crisis brought. Trauma is really about anything providing discomfort or distress to where an individual feels overwhelmed. It’s not something as obvious as getting hit by a car. Consciously, you can think some of this doesn’t bother you. But in the subconscious mind, trauma can exist. Everyone lost something from COVID. People lost jobs, loved ones and, by and large, their daily lives.”

On the positive side, the pandemic’s conditions have presented new opportunities for self-care for many people — with extra time at home for projects such as painting, playing music and experimenting with cooking and baking, more quality time with pets, additional emotional space to journal and a renewed premium on daily walks.

“There’s such a protective element to our routine, and our emotions get caught up in that pattern,” says Eric Beeson, president of the American Mental Health Counselors Association. “By being at home for several months, we had to readjust by finding normal in the abnormal. Normal had to be reconceptualized.”

That concept of normal was flipped upside down for clinicians too. The same focus on self-care needs to extend to therapists in their own lives and can be a unique blind spot, according to experts. Burns says she often reminds her counseling students that self-care works both ways and to practice what they’re so often taught to preach to clients.

“As counselors, when aspects of the client start matching you, then we run the risk of aligning with them and assuming what’s working for us is working for them,” says Burns, a member of the American Counseling Association. “Because of COVID, we were all going through the trauma and the grief process of our everyday lives at the same time. We cannot as clinicians expect to not be impacted by all this at the exact same time on a personal level. Then we add the extra layer of vicarious trauma from clients with intensified needs where we take on their pain. That all adds up to extra layers that cannot be neglected.”

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 emotional pace is an area for clinicians to pay attention to in working with clients.

“There’s been an overall shift in how we think about self-care as clinicians,” Litherland says. “Particularly during COVID, we should be asking ourselves, ‘How can I meaningfully and effectively engage in clinical work? Personally and professionally, am I able to buffer any side effect of burnout and compassion fatigue?’ Maybe we need 15-20 minutes in between each client because of our added pressures. Pace certainly matters for us because the speed of life right now feels fast.”

Litherland adds that with the heavy increase in telehealth sessions during the pandemic, self-care has become even more integral. “The volume can take its toll,” he says. “Particularly when we’re connecting through a computer screen, a video monitor, it’s a different mode of attending for us. We’re working harder to extract more information from limited data. The sessions might be doable, but the wealth and richness aren’t as easy to pick up as in person.”

Carol Park, CEO and founder of the virtual platform company Thera-LINK, says telehealth was already on the rise before the coronavirus pandemic. But shelter-in-place orders prompted a huge increase and reliability on digital therapy. The benefits for both clinicians and clients can be widespread, but Park notes that she’s found treating virtual sessions slightly different than in-person sessions can be helpful for clinicians’ self-care.

“People who were having struggles pre-COVID, now they were needing connection even more,” Park says. “Telehealth really has filled that void for clients. For therapists, it’s important to know that you’re not quite getting that neuroconnectivity element. You sort of lose that sixth sense. As a therapist myself, I’ll leave feeling a little bit more depleted. You work a little bit harder.”

As states have started to gradually open up establishments and shelter-in-place orders have lifted around the country, private practices and therapy businesses are also opening their doors. With some clients returning to work, that gradual adjustment can be mended in the therapy room.

“I think one of the most important things is being gentle with ourselves, accepting that things are different,” Litherland says. “We’ve all been through something. We have to look at what previously worked for us and feel out how it fits into a new reality.”

Beeson, who is also a licensed professional counselor in West Virginia and a professor at Northwestern’s Family Institute, says the initial concept of easing back into day-to-day life as a clinician (mirroring the process many clients were experiencing) was interrupted by current events. The killing of George Floyd while in the custody of Minneapolis police officers sparked nationwide protests and, from Beeson’s perspective, put a renewed focus on clinicians’ roles being about more than just sitting in the counselor’s chair.

“When you look at wellness models, they’ve become accentuated more now,” Beeson says. “Continued racism and violence and health care disparity have always been there. But they’re highlighted more now. So, my sense of getting back to normal might be more cannonball-like considering the sense of urgency I feel in my role as a professional counselor, leader and person. Sometimes that sense of purpose can be part of our self-care too. As we come back to our daily lives, things have changed. There’s a need to collaborate and come together now more than ever.”

 

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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.

Coping with the (ongoing) stress of COVID-19

By Lindsey Phillips May 21, 2020

The COVID-19 pandemic is affecting everyone differently. Some are coping with the loss of a job. Some are risking their lives caring for those who are sick. And others find themselves deeply contemplating existential questions of mortality and the meaning of life.

The pandemic could also be compounding underlying mental health issues for some clients, notes Robert Haynes, a member of the American Counseling Association. For instance, clients who were already battling depression or obsessive-compulsive disorder may now be dealing with a significant amount of anxiety and stress on top of that related to COVID-19. Those confronted with social injustices because of their race, ethnicity, sexual orientation or disability may also be more affected, he adds.

“People are going to be all over the spectrum as far as how they’re doing, what they’re doing and how it’s affecting them,” Haynes says. “Don’t assume anything, even if you’ve been working with a client for some time. This [pandemic] may be a huge setback for them.”

Many people have not dealt with this level of stress before, and some are having newfound anxieties, which can be jarring, says Shainna Ali, a licensed mental health counselor (LMHC) in Orlando, Florida. The pandemic may also uncover an unaddressed mental health concern that could benefit from counseling, she adds.

People’s ability to cope with stressful events has been and will continue to be tested by the COVID-19 pandemic. During this time when mental health is moving to the forefront of the public’s consciousness, professional clinical counselors are in a prime position to help clients cope with uncertainty and loss, build resilience, adjust their coping strategies and self-care routines, and identify their individual and community strengths. And counselors, of course, can best help their clients by remembering to also take care of themselves during this challenging time.

Coping with uncertainty

Uncertainty surrounds this global crisis. No one is quite sure what to expect or what the next day will hold. The uncertainty, fear and unknown with COVID-19 creates the perfect formula for anxiety, says Haynes, co-author, with Michelle Muratori, of the recently published ACA book Coping Skills for a Stressful World: A Workbook for Counselors and Clients.

A common response to this uncertainty is trying to seek control, Ali says. Throughout this pandemic, Ali, owner of Integrated Counseling Solutions, has constantly been reminding clients, “Manage what you can. Release what you can’t.” Fixating on what you can’t control leads only to rumination, but focusing on what you can manage is one way of coping with a stressful situation, she says.

For example, an adult client might worry about their parents and how well they are isolating during the pandemic. The client may want to visit their parents but also fear making them sick. Ali would advise this client to find another way to check on them (one that aligns with the Centers for Disease Control and Prevention guidelines) such as calling or doing a video chat.

“Focusing on what we can control might help us to feel more grounded,” says Muratori, a senior counselor at the Center for Talented Youth and a faculty associate in the school of education at Johns Hopkins University in Baltimore. Counselors can help clients set small, achievable goals and take time to reflect on what they have accomplished each day. For example, clients can ask themselves, “What is one thing I can do today to move toward accomplishing my goals?”

People can also control the type and amount of information they consume. As Stephanie Dailey, an assistant professor of counseling at George Mason University, points out, overexposure to media tends to increase people’s levels of distress, fear and anxiety during disaster situations, regardless of whether they were involved in the crisis.

“Accurate and timely information is important,” says Dailey, a licensed professional counselor in Virginia. “But if a client is constantly on social media and is accessing sensationalized or erroneous information, it’s going to undermine their mental health.” She advises counselors to inquire about how much access (or overaccess) to information clients might have.

Coping with loss

Not all loss is obvious. A couple mourn the cancellation of their vacation plans. A high school senior is upset because he won’t be able to experience graduation with his friends. A young child misses her first Broadway show. Neighbors are no longer able to relax and celebrate the end of a workweek by having dinner with one another in their homes on Friday night. Baseball fans lament the start of the season being postponed.

Loss is upsetting because it highlights what we no longer have or what we could have had, explains Ali, a member of ACA. She helps clients more fully understand what they are truly mourning and validates their appropriate emotional responses to the loss, such as sadness, anger and frustration. But she also helps clients see possibilities for experiencing gratitude even in the midst of loss.

For example, if a client is upset about not being able to get married when originally planned, Ali first reassures the client that feeling that way is OK. She may then ask the client to think about something for which they are grateful. The client may respond, “I still have my partner.”

Ali, author of The Self-Love Workbook and the blog A Modern Mentality (hosted by Psychology Today), finds gratitude a particularly valuable coping skill currently because “right now, it’s really easy to get distracted by the negative.” Encouraging clients to be grateful and to look for the positive isn’t meant to undermine or minimize negative emotions, she asserts. Rather, it deters clients from ruminating on the negative. 

Ali might also ask the client upset about their postponed wedding, “How can you still honor what you have?” This question would help the client refocus their energy on what can be managed (such as revising their wedding plans or planning an at-home date night) rather than wrestling with what is beyond their control, she explains.

Building resilience

Haynes and Muratori say that resilience is one of the key components of being able to cope with stressful events. Some people incorrectly assume that resilience is innate, but it can be learned, asserts Haynes, a clinical psychologist and producer of psychology video programs for Borderline Productions. “Resilience is more what you do than it is who you are,” he explains. And like any other skill, it grows stronger with practice.

Counseling techniques that help clients connect with others, adjust their thinking and beliefs, become more optimistic and flexible, practice self-care, attend to the spiritual dimension of life or promote self-compassion can bolster resilience, Haynes says.

In Coping Skills for a Stressful World, Haynes and Muratori share an exercise for strengthening client resilience. It involves clients tracking their reactions to stressful events for a period of two weeks and asking themselves some questions: What did they feel and think about the situation? What actions did they take to resolve the crisis? How effective were those actions? What did they learn? The exercise encourages clients to consider their own strengths and the ways they already cope with stressors. Clients come to the realization that they can use these same tools that they already possess when facing future crises, Haynes and Muratori explain. (The use of out-of-session exercises and activities such as this one is a major focus of their workbook.)

Ali works with clients to create their own toolkits of general self-care and coping skills that may be helpful during difficult times. It is important that people establish a general self-care practice rather than waiting to focus on coping skills during a crisis, Ali notes. She says that everyone’s coping skills during a stressful event will look different, but she advises clients (and counselors) to break into their “emergency coping kit” and find activities that help them manage stress.

Dailey, an ACA member who specializes in disaster mental health, finds ways to tap into her clients’ strengths to promote resilience and coping. If a client enjoys art, for example, Dailey may recommend painting or drawing as a possible coping tool. If a client is a natural helper, Dailey might have them brainstorm ways they could support others during the COVID-19 crisis, such as making masks or volunteering virtually. Spiritual or religious practices also provide an enormous amount of strength for some clients, she adds.

“Communities and individuals are innately resilient,” says Dailey, co-author of the 2014 article “Shelter-in-place and mental health: An analogue study of well-being and distress” for the Journal of Emergency Management. “Everyone has strengths, and this crisis can be an opportunity to find those strengths.”

As Muratori, an ACA member, points out, learning coping skills and resilience is not just something that will help clients get through the current COVID-19 crisis. It will also prepare them for future crises, large or small.

Adjusting coping and self-care strategies

“One of the skills in being resilient is also having some flexibility,” Muratori says. That is particularly relevant now because the COVID-19 pandemic has forced people to constantly shift and reshift their schedules while also creating new routines.

It is natural for people going through challenging times to engage in rigid thinking such as “I can’t stand this,” Muratori says. She advises counselors to remind clients that they are standing this; they are adapting and adjusting.

Many of Ali’s clients thrive with routine, but those routines have repeatedly been disrupted by physical distancing, quarantine and gradual reentry. Some of her clients were used to having a clear distinction between their home lives and work lives, so being forced to work from home has created new challenges for them around establishing and maintaining boundaries.

Ali works with these clients to recognize their personal boundaries and to establish some sort of new routine for themselves. She encourages clients to use a semistructured routine, in which they set their intentions for the day but also remain flexible to accommodate new circumstances as they arise.

Dailey also advises clients to maintain a regular routine as much as possible. She encourages them to focus on the basics, such as waking up, showering, eating and going to bed at the usual times.

Ali says that social connectivity remains an important coping strategy during the COVID-19 pandemic. “Social distancing and social isolation are not the same,” she emphasizes. Ali advises clients to think of creative ways to continue meeting their social needs. For example, if clients previously coped with a stressful workweek by going out to dinner with friends, perhaps they could consider hosting a virtual dinner party.

Likewise, clients may need to adjust their self-care regimens right now. After first defining self-care, Ali says, counselors can help clients brainstorm self-care techniques that have worked for them in the past and then look at how they can adapt those strategies (if necessary) to work in an environment of physical distancing or gradual reentry. For example, if a client previously coped with stress by going to the gym, how could they still fulfill that need while gyms are closed? Could they take a remote fitness class or go for a run instead? (For more on this topic, read Ali’s ACA blog post “Self-care & social distancing: Helping clients adjust during COVID-19” at tinyurl.com/ACAMemberBlogAli.)

“Any tools that will support relaxation are really critical at this time,” Dailey emphasizes. She finds mindfulness an effective technique for helping clients regulate their emotions because it encourages them to pause for a moment and let their bodies catch up with their brains. In turn, emotion regulation helps clients successfully manage their symptoms, maintain focus for day-to-day problem-solving and attend to physical needs such as eating, sleeping and taking the proper medications, Dailey says. Clients can journal, go for walks, spend time outside, exercise, meditate, do breathing exercises or do grounding exercises to manage their anxiety, she adds.

Counselors can also play a role in making self-care fun. To help boost self-care, Ali challenges clients (and herself) to combine various coping strategies. For example, a client could livestream a fitness class with a friend, or a family could do a gratitude reflection together at dinner.

Coping as a community

Muratori says that the COVID-19 pandemic exemplifies communal shared trauma — a traumatic event that affects an entire community directly, indirectly or vicariously. The good news is that community members are finding ways to support one another.

In Dailey’s community, neighbors stood on their porches one night and clapped into empty space to show their support for health care workers. They also placed stuffed bears with hearts on the chests in their windows to show their love for one another. Members of Haynes’ neighborhood also placed stuffed bears in their windows so children could go on a “bear hunt.”

Counselors can encourage clients to look around their communities and notice these resilient acts, Dailey says.

Ali specializes in individual mental health counseling, so her clients typically come to her to work on their own individual concerns. But since the COVID-19 crisis began, Ali has noticed that her clients are also showing more concern for the mental health of those around them, including family members, friends and neighbors.

Ali’s clients are also passing along their coping skills to others. One client noticed a roommate was anxious and suggested that they color together because coloring had previously helped the client manage stress.

Some of Ali’s other clients have been modeling the coping and communication skills they learned in counseling for their children at home. This includes using “I” statements, taking breaks and practicing self-care.

Ali also found a way to use her expertise to serve her community. Ali noticed a pattern of heightened stress among people in her life (herself included) because of the pandemic, but as a counselor, she also knew that this reaction was normal. She realized, however, that others in her community might not understand the emotions they were experiencing or know how to cope with the increased stress.

“This [pandemic] is not just exacerbating mental health concerns for people who are in counseling. This is also highlighting mental health problems for people who are not in counseling,” she says.

Of course, Ali couldn’t provide counseling to her entire community, so she and two other LMHCs, Candice Conroy and Sanya Matani, started offering a free virtual lesson to help people better understand and cope with the stress they might be experiencing because of COVID-19. The three LMHCs made it clear that the lesson wasn’t a substitute for counseling and provided resources for people to seek professional help.

Coping as a counselor

Haynes and Muratori express concerns about the stress levels counselors might experience throughout the pandemic and even after the initial threat subsides. “They need to take care of themselves better than they ever have before,” insists Haynes, author of Take Control of Life’s Crises Today! A Practical Guide.

Counselors need to apply the same coping strategies and tools to themselves that they give to clients, Haynes says. These include getting proper sleep, exercising, connecting with others, taking breaks, processing their emotions, turning off the news and getting outside.

Ali acknowledges that she has been feeling the stress of handling her own anxieties and concerns about the pandemic while also maintaining her current caseload. At first, the pandemic was the main topic for all of her clients, but this is evolving, she says. Now that most of her clients have adjusted to a new routine, they are again discussing their primary concerns that originally brought them to counseling. Still, Ali thinks it is important to do a quick check-in with her clients about how they are coping with the ongoing stress of COVID-19.

Self-care becomes even more important for counselors when sessions all deal with the same topic, giving clinicians few breaks to escape from it, Ali says. She has been coping with her stress by journaling, doing yoga, dancing, walking her dog, practicing mindfulness, reading, doing video chats and exercising.

Counselors need to remember that they are affected (whether directly or indirectly) by this pandemic too. Before the pandemic, most of Ali’s clients used traditional counseling, but with physical distancing rules in place, they now mainly use telebehavioral health. Ali acknowledges that staring at a screen for long periods of time has been taxing for her.

Taking breaks from the screen and using a semistructured schedule for both her personal and work schedules have been helpful coping strategies for her. When she feels particularly overwhelmed, she also practices a “digital detox,” putting her digital devices away for a day and focusing on her self-care to find her equilibrium. If a complete digital detox seems intimidating to counselors or clients, she encourages them to create small, manageable digital boundaries such as stepping away from their devices for a few hours or setting a timer to minimize their use of electronics.

For counselors in private practice, isolation can be another pronounced risk during the pandemic, Haynes points out. He highly recommends that counselors seek out colleagues for consultation, support and supervision during this stressful time.

Much like counselors advise their clients to look for individual and community strengths, clinicians can listen for examples of clients’ resilience, Dailey says. This may result in vicarious resilience, a concept developed by Pilar Hernandez-Wolfe, David Gangsei and David Engstrom in which therapists experience their own personal growth by witnessing and recognizing the growth of their clients.

Adjusting to a new normal

Even after the number of COVID-19 cases subsides, life won’t just go back to normal. The reentry process is going to upset people’s routines all over again, Haynes predicts. For that reason, he and Muratori advise that counselors prepare to take a more directive stance with some clients and focus on their life skills during the transition back toward a “new normal.”

Counselors may need to provide clients with guidelines, instructions or demonstrations, or they may have to model or teach clients new skills, Haynes and Muratori say. For instance, some clients who have been laid off may need help filing for unemployment, conducting a job search or applying for new jobs. Others may need guidance on how to safely reenter their workplace or physically interact with family, friends and community members for the first time in months.

Counselors will also have to help clients manage expectations, Dailey says. For example, many clients may now be dreaming of returning to work, but when that finally happens, they could very well find themselves stuck in meetings again and wondering what their kids are doing at home. Likewise, parents feeling impatient about their children returning to school may have forgotten what the old morning struggle was like to get everyone off to school and work on time.

Adjusting back to something resembling the previously normal routine as stay-at-home orders are lifted will take time. Dailey thinks the adjustment will come in phases. People returning to work will be one round of adjustments. Then there will be another adjustment period as schools attempt to reopen in the fall. 

It is also important to note that clients won’t just be going back to “work as normal,” Dailey says. Even if they return to the same job and the same physical work location, things promise to be different in the wake of COVID-19. These differences may cause some clients to feel relief, whereas others will experience a new round of anxiety and fear.

Dailey compares these adjustment phases to a flipbook. Everybody has their own unique story with the pandemic, and every page of the flipbook represents a new experience, a new adjustment. Counselors can help clients process and cope with these adjustments by “flipping” through their stories, stopping at certain points, and assessing how the clients reacted and coped with that part of their story. The tools they used to cope — making art, meditating, sewing, exercising — are ones they can use again in the future as they adjust to a new phase, Dailey says.

The COVID-19 pandemic possesses the potential to change the counseling field and how professional counselors work with clients now and in the future, Haynes says. Since the turn of the century, it’s true that the United States has experienced major crises such as 9/11, large-scale natural disasters and the Great Recession, but, as Haynes points out, there hadn’t been a crisis on a global scale like a world war until COVID-19. This experience could shift the focus more toward prevention and preparation (both for individuals and for systems on a national level) for future crises, he says.

Adjusting to this new normal doesn’t have to be all negative. Once we reenter society after the threat of COVID-19 subsides, we will be able to celebrate regaining some of our old coping strategies as well as the acquisition or discovery of new strengths along the way.

Counselors are in position to help clients gain greater perspective and self-awareness while coping with the stress and loss that the pandemic has introduced, Ali says. To aid in that process, she sometimes asks clients who have already adjusted and are successfully coping with this stress and loss, “What are you learning during this time?”

In asking that question, Ali has found that several of her clients now understand how the coping skills they previously learned in counseling have helped them handle this stressful moment in history.

How we cope with the stressors of COVID-19 can tell us a lot about ourselves, Ali says. While it may be unpleasant, we can use these times as learned lessons that will help us continue to adapt and manage stressors in the future.

But for now, just take a deep breath.

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.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.

The hurting counselor

By Gregory K. Moffatt August 13, 2018

It was like someone was sitting on my chest. From the moment I awoke each day, I could barely breathe, and throughout the day, I teetered on the verge of tears. My wife and I had separated, and I thought my 20-year marriage was about to end. My heart was in shreds and, especially because I am a counselor, I was humiliated that I was failing in my marriage. I felt like a fraud in front of my students, and as I struggled through lectures, the words and ideas that left my lips — the ones that normally were energizing to me — now seemed hollow and pointless.

I also struggled to get through my clinical appointments. As one married couple talked about their own pains, resentments and disappointments, I felt so incompetent that it was all I could do not to send them out the door. My worldview — everything I thought I believed in — had been shattered.

And, of course, I also had to face my children, explain things to my extended family and tell my close friends about my troubles. One of the most painful things ever said to me was delivered by one of those people at the time, like a spear thrust into my chest: “You might be a good counselor, but you sure don’t know how to practice it at home.”

It was an impulsive statement not intended to wound me, but those words sealed my burgeoning perception that not only had my marriage failed, but the successful person I thought I had become was merely an illusion. Many times I had talked to others about how failing didn’t make them a failure, but I couldn’t apply those words to myself. I believed I was indeed a failure. Nothing had prepared me for the crippling effects of such a personal crisis on my professional sense of competence, my worldview and my sense of self.

Those days are long behind me now, but the devastating feeling of that painful period was brought back to me recently as I worked with a colleague in the midst of a similar experience. Even now, after many years of healing, that wound is still tender in my heart, and as my colleague talked to me, tears pooling in his eyes, I knew there was little I could say to ease his pain. I recognized that fractured sense of competence in his face. It was the same one that looked back at me from the mirror all those years ago.

Children or no children, short marriage or long, amicable divorce or contentious, splitting up is always painful. I loved my family, and I was willing to do anything to salvage my marriage. In retrospect, that difficult time was one of the best things that could have happened to me. It helped me become a better person, and it helped my wife and me to heal some very deep hurts and disappointments and to begin nurturing a much healthier and happier relationship — one that thrives like wildflowers today. But that experience also taught me that the pain of personal crisis, whatever the cause, can be debilitating to a counselor.

A hard fall

As a professor, writer and clinician, I had always prided myself on practicing the things I taught. Looking back on those years, maybe I succeeded much of the time, but I failed more than I realized. I suppose counselors require a sense of competence, maybe even bordering on arrogance, to take the risks we take each day. After all, we are diagnosing and treating based on a professional judgment call, and if we didn’t have confidence in our abilities, we probably wouldn’t be very good at what we do. We might otherwise stand on the riverbank, foundering in indecision, never daring to venture across.

But that confidence and self-assurance may also blind us and make our fall much harder. As is also true for politicians and religious leaders, people expect more of counselors than perhaps they should. We are, after all, human. But a personal crisis, regardless of whether it is one of our own making, is not just our own. Our pain, embarrassment and shame are inevitably known to many and reflect, however unfairly, on our professionalism. That adds to the weight of our sorrows.

The self-care paradox

There is no shortage of books and articles on self-care for therapists. A quick search in an academic database yielded almost 1,000 articles on the topic. We talk a lot about self-care in our field, but I know that I didn’t practice it well. I suspect I am not alone — and this isn’t a new problem.

My professors and internship supervisors talked about the importance of self-care when I was a graduate student in the 1980s. In 2000, Theresa O’Halloran and Jeremy Linton noted that “wellness is a concept that we as counselors often focus on more readily for our clients than ourselves.” Then, almost 20 years after that, Denis’ A. Thomas and Melanie H. Morris (2017) wrote, “Although most counselors have knowledge about self-care and convey the importance to others, the same knowledge may not translate into self-care action — often when it is needed most.” Apparently, as a group, we practitioners haven’t learned much about the application of self-care in our own lives over the past few decades.

This is such a bizarre paradox. Counselors, of all people, should know better. We are trained to take care of ourselves, and we emphasize the importance of self-care to our clients. Yet my self-confidence in those days caused me to naively believe that crisis wouldn’t knock on my door. I think in some ways, when counselors talk about self-care, it is more of an academic conversation than a real one. It may be something like the fact that we all know we are going to die someday, but it isn’t real to us until we stare it square in the face.

Divorce, death of a loved one, loss of a job and chronic mental health issues strike counselors’ homes and lives just as they do the rest of the population, and these issues are potentially just as damaging to us as they are to those who are not in the field of mental health.

I couldn’t have prevented the pain of my own crisis, but there are many things I could have done differently to prepare myself for it. My self-care habits back then were weak at best. I’d like to offer some suggestions that can help counselors navigate the sweeping effects of personal tragedy.

Find a counselor before you need one

Unfortunately for me, when the reality of my fractured marriage came calling, I didn’t already have a personal therapist. I had seen one in the past, but I hadn’t had an appointment with him in years, so long that I couldn’t even remember his name.

I should have known better. All of us learn in graduate school that we need to manage our own issues if we want to be effective therapists, and I had been through both individual and group counseling as a part of my graduate work. I thought I had done enough. I reasoned that I had worked through past issues and found a place for my own life’s traumas. Maybe I thought I had “arrived,” but I was kidding myself. Managing the past helped to some degree but not with maintaining my ongoing mental health. Consequently, I wasn’t growing either.

It is easy to rationalize that the cost of regular therapy — both in time and money — doesn’t make sense. We work hard as counselors, and for every hour we spend in our own therapy, we are also losing money because we aren’t seeing clients. But that is false economy. Even if we are managing life fairly well, it still helps to get a checkup. I get a physical every year even though I’m fine; I go to the dentist twice a year even though I don’t have cavities; and I go to the eye doctor each year even though my eyesight is OK. I should have applied the same philosophy to my mental health, getting a mental health checkup every few months at minimum.

So, there I was, in crisis and in need of a therapist, and I had absolutely no idea who to turn to. Plus, I had another serious dilemma that is common among counselors. Almost everyone I knew and trusted in the field couldn’t ethically see me as a client. They were friends, colleagues, former students or former supervisees. I’d consulted with them, taught them or socialized with them. Now I had to find a therapist in the midst of my crisis, and I was left with the phone book — something I always tell people to avoid.

If I had been maintaining an ongoing relationship with a therapist already, this part of my crisis management would have been simple. For that matter, it’s very likely that at least some of the crisis itself might have been avoided. I’ll never find myself in that place again.

Exercise, eat right and rest

Good mental health requires us to eat right, sleep right and get reasonable exercise. I call it “Moffatt’s Mantra,” something my students, interns, supervisees and clients undoubtedly get tired of hearing.

Even before my crisis, I slept poorly, sometimes getting only an hour or two of sleep a night. This went on for years, and just as I apparently had been doing with my personal life issues, I chose to ignore my sleep issues. Oddly, my sleep problems allowed me to be exceptionally productive. Getting to my office sometimes at 1:30 or 2 a.m., I wrote prolifically, publishing many books and articles as a result. But then, in the midst of crisis when I desperately needed rest, even the little sleep I ordinarily might have gotten evaporated. I was preoccupied with shame, regrets and hopes, and sleep was nearly impossible. I made an appointment with my prescriber and began taking regular sleep aids, which was critical to my healing. Almost immediately, a reasonable night’s rest helped my mood improve.

Likewise, in those days, I rarely ate breakfast and often skipped lunch, only to overeat at the meals I did have. Fortunately, I have never been one to eat junk food, but my Southern diet was full of fried foods, fats and carbs. When crisis hit, I couldn’t eat at all. My stomach was upset, and I had a hard time downing even a few bites. Over just a few weeks, I lost more than 20 pounds. Just as was true with my sleep patterns, crisis magnified my poor eating habits. A good friend forced me to eat, often sitting with me during meals — including some that he made himself — to ensure I was getting at least some nutrition.

Of the three areas that constitute Moffatt’s Mantra, exercise was the only one that came easy to me. I have always been good about getting some type of daily exercise — running, biking, swimming or even all three in one day. This is the only thing that helped me offset the fatty, fried-food diet that was my routine and prevented me from gaining unhealthy weight.

Exercise has myriad benefits. Aside from building endurance, muscle tone and a stronger heart, it also improves quality of sleep and mood in general. Research has demonstrated that attention to healthy, reasonable exercise can either lessen the demand for medication or remove its necessity altogether, even with serious issues such as chronic depression. Exercise produces morphine-like endorphins that help to balance our moods. Even moderate exercise just two or three days a week can help manage weight and increase metabolism. Seeing a thinner self in the mirror can also improve mood.

“I’m too busy to exercise” is a very weak excuse. I was very glad that I didn’t have to add exercise to my life during the crisis because I doubt I would have possessed the motivation to work out and try to get in shape.

Supervision

Most counselors engage in supervision until a license or related credential is achieved, but after that, they rarely pursue any form of formal supervision. I think that is a mistake. As a supervisor myself, I have to recognize when a supervisee’s personal life issues, whatever they may be, are interfering with clinical practice without crossing the line and functioning as my supervisee’s therapist.

It would have been wise to have a second set of eyes during my crisis to evaluate my competence and ability to work with the clients I continued to see. An ongoing relationship with a trusted mentor or supervisor not only helps make us better counselors, but our supervisors may also be able to recognize when we are off our game. We lack objectivity when it comes to our own lives — both professional and personal.

That well-known line, “Physician, heal thyself,” sounds good, but it is an unattainable goal. Looking back at my own history, I was totally blinded by limitations of maturity and knowledge as well as by my good intentions. It is only through the lens of time that I am able to see that now. There is no way I could have been fully aware back then. Retaining a mentor who could have helped identify when it was time for me to take a step back would have been advisable.

Don’t forget to play

Building a private practice takes time, and many counselors burn the candle at both ends, working late hours and weekends, and seeing 35 to 40 clients per week. Such a schedule is unsustainable without life balance.

There is a huge body of research cataloging the benefits of play. It used to be thought that play was a kid thing. That is absolutely false. Human beings — in fact, most mammals — are prewired to play. The need to play doesn’t end at some arbitrary age that we call adulthood.

In general, research demonstrates the health benefits of play when it offers enjoyment and when the participant suspends time and place in exchange for focusing on an entertaining goal, such as winning a board game, playing tag or shooting basketball. Adults who play are happier and manage stress better. Play boosts morale, improves our “marketability” with the opposite sex and reduces heart rate. A 2016 study in the American Journal of Play even demonstrated the need for play among astronauts and proposed that NASA formally develop a “playscape” for those in microgravity.

Golfing, biking, hiking, playing games with your children or putting together a jigsaw puzzle are only some of the varied activities that constitute play. My favorite play activity these days is camping, and I am in the woods at least one or two days a month throughout the year — rain or shine, hot or cold. The isolation and recreation of the mountains energizes me and recharges my batteries.

Know your limits

One of my strengths in life is that I have never once done anything simply for money. Money doesn’t own me, so nobody else does either. But it is an easy mistake to make, especially as an American, to keep striving for more — a bigger house, a larger counseling practice, more staff, one more speaking engagement, more clients and so on.

Even when your practice energizes you, there has to be something more in life than appointments. It seems so logical, however, to keep taking on new obligations, mistakenly believing that you are “building a practice” when, in fact, you are burning the bridge from both banks. Long-term goals require some sacrifice, of course, but the decision of what to do and what to cut should be based on something other than the bottom line of your bank account or an arbitrary conceptualization of success.

Another reality is that in the midst of crisis, you can’t expect yourself to perform at the same level you would when your life is more normal. When I plunged into crisis, I cut back on as much as I could. I still had to teach my classes, and I continued to see the clients on my caseload I felt I could ethically handle. But I took no new clients, accepted no new speaking engagements, put all of my writing projects on hold and cleared my calendar, canceling a number of events I just didn’t feel strong enough to manage.

You will assume that this article doesn’t apply to you

There are varied perspectives on self-care, but I particularly like O’Halloran and Linton (2000), who propose focusing on wellness in six domains: social, emotional, cognitive, physical, spiritual and professional. Prior to my crisis, I had focused only on one or two of these, even though self-care is mandated by the ACA Code of Ethics. The suggestions I have offered about self-care are a start, but if history has taught me anything, I predict that most readers will say to themselves, “That was an important article. Glad it doesn’t apply to me.” And then 10 or 20 years from now, somebody else will be writing an article for counselors addressing the need for self-care. I would love to be proved wrong.

Just because we are counselors doesn’t make us immune to the ills of life any more than an oncologist is immune to the risks of cancer. In the 1990s, when Elisabeth Kübler-Ross experienced a series of serious health issues, she recanted her “stage theory” completely. A full-page article in my local paper described her health woes and her disparaging comments regarding her theory. I thought at the time her recanting of the theory was, ironically, demonstrative of the anger stage of that very theory. Before her death some years later, she said as much and reaffirmed her personal belief in her theory and life’s work. Despite our knowledge and experience, a crisis blinds us. Affect always trumps logic.

Taking good care of yourself is not only healthy for you, it will help you better serve your clients. Even chronic mental health issues such as depression do not preclude our competence. One of the most influential people in my professional life endured a lifelong battle with depression. I had known her a very long time before she confided that information to me. But she was an amazing mentor whose words and example influence me to this day. Likewise, one of the most naturally gifted interns I have ever had was a woman who suffered major depressive disorder, marriage issues and significant self-esteem issues throughout most of her life. But when she closed her door to begin therapy with her clients, she was amazing.

Both of these women were surprisingly strong, despite their personal life frailties. I am confident that they had learned to manage their challenges — not avoid them — and had developed self-care processes that allowed them to flourish in the counseling room.

It is with some embarrassment that I share my personal failures with you, but as always, this isn’t about me. Instead, I am hopeful that sharing my struggles can help you to avoid the mistakes I made. Pain will eventually find us all. I hope that, with better preparations than I made for myself, you can be prepared to weather the inevitable storms on your own horizons.

My friend has a very long road ahead of him. Recovering when your world lies in tatters around your feet is overwhelming. But he has me — a friend and a confidant. He has his therapist. And he has the physical and spiritual health to face this daily challenge. That is a great start.

 

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Gregory K. Moffatt is a professor of counseling and human services at Point University in Georgia. He is a licensed professional counselor and a certified professional counselor supervisor. Contact him at greg.moffatt@point.edu.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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Related reading, from the Counseling Today archives:

The battle against burnout

A counselor’s journey back from burnout

Wellness matters

Doing our own work: A parallel process

Behind the Book: Counselor Self-Care

 

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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.

Cole delivers message of care and empowerment in Saturday keynote

By Jonathan Rollins April 28, 2018

Johnnetta Betsch Cole couldn’t help but chuckling at the audacity (or, as she phrased it, the “chutzpah”) of the keynote message she was about to deliver to the thousands of counselors congregated Saturday morning at the ACA 2018 Conference & Expo in Atlanta.

With charismatic presence — and a knowing sense of humor — Cole announced to the assembled crowd, “I’m going to give some good counsel to a bunch of counselors.”

Cole followed up by saying that she wasn’t bringing new words of wisdom. Rather, she said, “You’re going to have affirmed what you already know but what you may not be acting on.”

Johnnetta Betsch Cole gives the keynote address at the ACA 2018 Conference & Expo in Atlanta on April 28. (Images by Paul Sakuma Photography)

An educator, anthropologist and humanitarian, Cole was the first African-American woman to serve as president of Spelman College and later served as president of Bennett College. Spelman, in Atlanta, and Bennett, in Greensboro, North Carolina, are two historically black colleges that are dedicated exclusively to educating black women. Cole was also the director of the Smithsonian’s National Museum of African Art. In introducing her to conference attendees, ACA President Gerard Lawson noted that Cole “has tangled with inequality in all its forms.”

Cole opened by welcoming the “sisters, brothers and siblings all” in the audience. In a nod to her training as an anthropologist, Cole said that she was purposely using “kinship terms” in her greeting. “I know that kinship is about much more than blood,” she said, explaining that it is really about how people are connected by their shared values and beliefs. Among the values she knows that counselors share, she said, is the belief that “every child deserves the right to soar to the heights of their possibilities” and the worth of the extraordinary diversity among all human beings.

Cole then proceeded to remind the counselors in the room of some truths they already know but may need to rededicate themselves to in their practice.

First, Cole said, “It is immensely important for you to truly know the folks you are working with — their struggles, their lives and their culture. … You cannot be an effective counselor unless you genuinely find a way to walk in their moccasins or roll in their wheelchair” or understand what it is like to be someone who is transitioning genders.

Second, she said, “To serve as an effective and compassionate counselor to others, you first need to really know yourselves.” This involves a significant amount of soul searching and engaging in personal therapy, Cole acknowledged, but it also requires “understanding and owning your unconscious biases.”

Every single human being possesses these unconscious biases, Cole said, and they affect how we view and evaluate others and ourselves. “We’ve got to be aware of our unconscious biases. Why?” asked Cole. “So we can mitigate against them.”

Third, as counselors work with students and clients from marginalized groups in society, Cole said, it is extremely important to help these individuals “acknowledge, own and execute their power … to become champions for themselves and for their community, their nation and the world.”

Cole recalled a middle school teacher who helped her to realize and claim this power in her own life. Cole was attending a private school where almost all of the teachers were white, including this particular Latin teacher, Miss Morris, whom Cole remembers as having “tightly permed hair with too much blue rinse in it.”

At this particular age, Cole said, she was beginning to “feel my power,” and she decided to direct it against Latin itself, organizing “her girls” to disrupt the beginning of class with a rhyme about how the rigors of Latin was killing them. After two days of this, Miss Morris stopped the girls and told them that they weren’t there to learn Latin. Using the language of the day, she told them, “You’re in this class to learn that, as negro girls, you can learn anything.”

“That is a message that we should give to every child,” Cole said.

That message should also stir up something in us to claim and use our own power to effect change in our own lives and communities, Cole said, adding that there is no shortage of issues in our society needing nonviolent action on the part of people.

When encouraging people to tap into their power, Cole likes to reference an African proverb: “If you think you’re too small to make a difference in the world, you’ve never spent the night in a closed room with a mosquito.”

In closing, Cole gave the counselors one last reminder: “Each of you is in the business of teaching your clients and students how to take better care of themselves. But in addition, dear counselors, you’ve got to take good care of yourselves.”

Cole then asked for the house lights in the ballroom to be brought up and requested each of the counselors who were able to stand. She told them to get in a comfortable stance, to bring their right arm across their body and then their left – and then to give themselves a big hug.

“I’m asking you to do better at loving and empowering yourselves,” Cole said to the attendees. She then asked them to take that message of care and empowerment to their students and clients so that they, in turn, could work to improve their communities, put a message of love and respect into action, and pursue social justice throughout society.

Cole may have been preaching to the choir, but her message unquestionably rang clear and true.

 

 

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Jonathan Rollins is the editor-in-chief of Counseling Today. Contact him at jrollins@counseling.org.

 

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The ACA 2018 Conference & Expo in Atlanta began with an ACA Governing Council meeting mid-week; festivities stretch through the weekend.

Find out more, including information on live streaming, at counseling.org/conference

 

See more photos from conference on the ACA Flickr: bit.ly/1MOAysM

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Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

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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.