Tag Archives: Shelter in place

For such a time as this: A plan of action for couples and individuals

By Esther Scott June 15, 2020

[Editor’s note: This is the second of four articles in a series on action plans for different areas of life during the COVID-19 pandemic. The remaining articles will be posted on subsequent Mondays in June.]

The new normal that the coronavirus has introduced can create some real tension, particularly for couples who think they are losing “that loving feeling” as a result of the shelter-in-place mandate meant to contain the spread of COVID-19. Every marriage has its natural ups and downs, but research studies suggest that the way we relate to each other can have profound effects not only on our mental health, but on our biological health as well, “for better or for worse.”

This unplanned for and prolonged time to stay at home may bring discomfort for many of us, but we can come out the other side with new skills. Having a plan of action can help protect your relationship during these changing times and may even help reignite the spark that brought you together in the first place.

Here is an action plan to follow to help you reclaim your “happily ever after” even during the coronavirus pandemic.


1) Bring back that loving feeling. Be more proactive.

Early in relationships, we prioritize our one-on-one moments, but eventually we begin to sideline, just when we may need to connect the most. To “bring back that loving feeling,” research shows that couples should engage in meaningful activities to stay connected with each other. It could be as simple as trying a new weekly schedule that includes a night for reading or listening to music, a night for TV, a night for conversation and so on.

One exercise we recommend to the couples who come to see us is to put a big fluffy pillow in the middle of their living room or bedroom floor, grab their favorite drink (e.g., a bottle of wine, sparkling apple cider, tea), turn off cell phones and TVs, turn the lights down low, play soft music in the background, and simply talk to one another for 45 minutes. We recommend they do this at least once a week.

No one enters a relationship with the expectation that it will be boring or unhappy. Boredom signals that our relationship needs to be refueled. Just as the fuel light on your car indicates when you are running low on gas, boredom and unhappiness mean that your relationship needs to be refilled. You wouldn’t think of abandoning your car when the fuel light comes on; you would think of refilling it. The same goes for relationships.

Boredom and “unhappiness” do not mean that a relationship does not work — it just means that it needs some attention. Early in the relationship, everything is new and exciting. We talk for hours, text countless times and spend every second we can together. Then, somewhere along the way, we believe we have shared all there is to share and know all there is to know about each other and we stop connecting, which can lead to a sense of boredom and unhappiness. We need to continue cultivating those opportunities that helped our relationship to grow in the first place. This, in turn, will help bring back that loving feeling.

2) Focus on supporting each other.

Can I depend on you when I need help, feel scared, worry about dying or don’t feel well? Am I willing to be that source of comfort and stability when you need me? These are questions the subconscious mind has kept in storage from the moment you decided to join your lives together.

No matter how long you have been together, the current pandemic has revealed the need for much more mutual dependency. Now is the time to give reassurance that your partner can count on you to protect them by protecting yourself. Now is the time to provide empathetic listening when they are feeling scared about their future or frustrated with the new changes and losses experienced. Now is the time to support each other.

3) Talk to connect. Connect through agreement.

Instead of talking about what is not working, have a conversation about the needs you both have and how to satisfy each other within your relationship. Try focusing on what is good about your relationship, what you admire and what you feel grateful for. Once you show appreciation for each other, it is likely that both of you will have a change in attitude.

Research shows that if you focus on the ways your partner is supportive, both you and your partner will feel better about the relationship. Connecting this way increases your chances of standing strong through the storm. Use this crisis as a call to action.

We continue to change and grow every day. The problem is that we have stopped sharing. Talk to connect! Ask questions: “How do you think the world has changed since COVID-19?” “What is something you truly enjoyed doing that you have not done in years?” “What is the best way for me to encourage you and support you?” There is still plenty to discover about each other.


Note for dating couples

Adversity can sometimes make a relationship stronger. COVID-19 may have intensified your relationship more quickly than it would have otherwise. Use this opportunity to examine your partner’s character during this crisis.

Character is the first thing to inspect before marrying someone. Your potential spouse can have good career and a strong personality or be fun loving and good looking, but if there is a character problem, these other qualities will not matter. Your character determines your commitment to the relationship, and commitment is the essential ingredient that will help you build a lifetime of enjoying one another.

The following questions can help you identify potential character issues that will need to be addressed to keep your relationship healthy. Most of these questions can be answered simply by watching a person’s behavior around family and on social media.

  • How do they handle stress or crisis situations?
  • Are they teachable?
  • How well do they set healthy boundaries in their life?
  • How do they handle money?
  • Are they angry or hot-tempered?
  • Do they follow through on commitments?
  • Do they demonstrate respect for others?
  • Are they entitled?


Plan of action for individuals

If you are going through COVID-19 alone, the lack of social connections and the disruption in routine can impose additional stress that can lead to depression. These feelings of association and loneliness are flexible and change with context. In fact, things may get worse before they get better. What felt manageable yesterday may not feel manageable tomorrow. Here is a plan of action for you.

1) Change your perspective.

You may find yourself riding this wave “alone,” but it is important to remember that you do not have to feel lonely. This is a global pandemic. We are all in this together, even if we are physically apart.

Now is the time for a change in perspective. Remember, perception is reality to those who perceive it. Your world is built from the inside out, from your brain. If you perceive your time alone as lonely time, then you will feel lonely. But being alone is not the same as being lonely. On the other hand, you can be in a relationship or surrounded by people and still feel unsupported and lonely. Use your situation as time of reflection. Solitude can be a season for us to reconsider what is important in our lives.

2) Reach out and connect.

Now is the time to reach out to friends and family and connect with them in a more meaningful way. Let people know how much you care about them. A phone call, involving a real voice instead of a text message, is better, and a video chat instead of just a phone call is best. Humans were created to be social beings, and hearing a real voice and seeing the faces of those we care about is exactly what we need in times of crisis.

Talking about your feelings with someone when you are stressed or upset may or may not resolve your problem, but it can help you to feel better and less alone. If, on the other hand, you are on the receiving end of the call, be the support that person needs. Listen and convey that you understand their feelings. This act of one person sharing something vulnerable and the other responding with understanding and care is what we call empathetic listening.

3) Avoid unhealthy coping mechanisms.

Avoiding unhealthy coping mechanisms such as pornography, alcohol or drug use can prevent long-term complications. The spread of the coronavirus and the necessary physical distancing measures put in place have led to increased feelings of loneliness and stress, which can help explain the reported increase in pornography use. Some claim that pornography does not present a problem for those who use it. However, a number of research studies show links between pornography use and potential concerning outcomes, including lower levels of sexual satisfaction for men.

Alcohol and substance use are also popular coping mechanisms among those looking to reduce feelings of stress, loneliness and boredom. However, alcohol and substance use could do more harm than good and could lead to a possible spike in addiction disorders for years to come. Health experts warn that an increase in alcohol and drug use could have both short- and long-term impacts on health and safety.

To avoid the potential harm of relying on unhealthy coping mechanisms, we recommend using humor and creativity to reduce stress and boredom. Using humor does not mean that we are trivializing the challenges brought to us by the coronavirus; it means we are trying to cope with them in a healthy way. Laughter is the best medicine, and humor can improve our mood and increase our resilience.

The movie Groundhog Day offers a great example of how many of us may be feeling. Every day seems to be a repeat of the last. But remember, even though it was the same day over and over again, the main character in the movie had the opportunity to learn something new every day. You may be alone, but you do not have to feel lonely. We are in this together with our friends, family members and even the entire global community.



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.





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

How to help domestic violence clients during shelter-in-place situations

By Federico Carmona April 13, 2020

It’s heartbreaking to read the variety of articles circulating about vulnerable people trapped at home with their abusers because of shelter-in-place mandates during the COVID-19 pandemic.

Unfortunately, experience reminds us of a concerning reality that is typical of these uncertain times: Adverse labor market conditions are positively related to domestic violence. Research conducted after the Great Depression of the 1930s, the farm crisis of the 1980s, and the Great Recession of 2008 found that economic crises have significant negative effects on the quality of intimate relationships and parenting in working families. Marital conflict, abuse (particularly violent controlling behavior), and a decline in parenting quality are among the harmful effects in families of a macroeconomic downturn.

In my role as a trauma therapist, I have seen dozens of domestic violence clients during clinical intakes and in counseling. I have also read a multitude of articles on the subject about studies and reports from different parts of the world. Shelter-in-place mandates aren’t a good thing for women and children who are the targets of abuse. The anticipatory anxiety and uncertainty of these times can cause negative emotions to churn, leading to behaviors that increase the already-concerning number of domestic violence and child abuse cases. There is no “how-to” manual to deal with the current situation, of course, but the safety of this vulnerable population demands us to do our best.

How can the counseling community help domestic violence clients who are trapped at home with their abusers? I offer a few suggestions:

Reach out between appointments/sessions. One of the critical signs of abuse is the isolation of victims of domestic violence from their networks of love and support. An occasional check-in from us can empower these clients to tell us more about their situations and perhaps even dissuade their abusers from further violence as we keep checking in.

Listen, just listen. People experiencing domestic violence need an empathic ear — someone who will allow them to vent their repressed emotions and feelings without judgment. We are not to offer advice, only listen and empathize. It’s just time to build trust.

Validate clients’ feelings, emotions and beliefs even when they don’t make sense. The best way to build trust with clients experiencing domestic violence is by being present with them. We’re present with them through our vicarious empathy, active listening and compassionate validation. Our empathy is vicarious because it takes an emotional toll to connect with someone’s anguish and suffering. Active listening requires us to be disciplined enough to fully concentrate on what the client is saying rather than on the answer that we might have in mind to their situation. Clients experiencing domestic violence require validation — compassionate validation — because many times, their decisions (or lack of them), circumstances and beliefs don’t make sense to us.

Introduce them to mindfulness exercises. Clients experiencing domestic violence live in a world of fear and anxiety because of the cycle of abuse. At first, they’re worried because of their confusion and inability to make sense of and control the incipient abuse. In time, as the abuse increases, worry turns into anxiety and fear.

Mindfulness can help these clients become aware of their emotions, thoughts and bodies to take control of them and find much-needed relaxation. Meditation exercises shouldn’t necessarily be long. There are plenty of sites online with short, simple exercises, from breathing to stretching, that can help clients gain the bodily and emotional awareness they need to function.

Remind clients of their strengths and qualities. One of the benefits of practicing active listening is the ability to notice in clients’ stories what they have forgotten about themselves: their own power, qualities and strengths. By doing this, we help clients not only to survive their circumstances but also to move toward a better future as survivors of domestic violence who deserve lives of meaning and purpose.

Help clients to start a project. Because of shelter-in-place mandates, more perpetrators of abuse are at home all of the time. This increases the emotional state of “walking on eggshells” for domestic violence clients. We can help distract these clients from that state by brainstorming with them or suggesting a project to them. It could be an individual project based on their abilities, strengths and qualities that we noticed in their stories, or it could be a project that involves their children.

Assist clients in making a safety plan. Making a safety plan is incredibly useful. It doesn’t need to be complicated or lengthy. The simplest way of doing this is by helping these clients become aware of their circumstances (call the problem what it is — domestic violence). The rest of the plan might involve:

  • Trying to avoid conflicts and arguments during the mandated confinement
  • Involving their children in most of their home activities
  • Reaching out to relatives and trusted friends (when possible)
  • Being prepared to leave at any moment (i.e., having money, documents, car keys, children’s backpacks filled with some clothes and snacks ready to go)
  • Calling 911 when they feel that they or their children are in danger (even in a shelter-in-place situation, law enforcement will issue an emergency protective order to separate victims from their abusers)

Involve others. We can help our clients experiencing domestic violence to think about the resources they possess to deal with their situation. One of these resources could be men who are part of the couple’s life in some way (e.g., clergy, friends, relatives, co-workers, classmates, teachers, bosses).

When families and friends get involved, perpetrators of abuse can sometimes be dissuaded from causing harm to their partners and children. The presence of fathers, brothers, neighbors and friends prompts accountability. Some of these individuals might be willing to offer their support and speak up against the ongoing abuse. Victims of domestic violence can only break their silence and become survivors if they feel supported. We need to be cautious, however, and see each client in their particular context, giving consideration to whether this type of intervention could put them in more danger than they already are.

Help clients build a network of support. Isolation is one of the most critical signs of abuse. It creates a hated dependency on the abuser. Imposed isolation robs victims of domestic violence of their personhood. It suppresses their voice and identity piece by piece as family members and friends are pushed away. Connections are the simplest way to beat domestic violence. It is critical that victims of domestic violence get reconnected with relationships they trust. It is also crucial to get these clients connected with other survivors of domestic violence (via online groups) so they can claim their victory and begin the journey of healing from the trauma caused by the abuse.

Inspire clients to pursue self-sufficiency. Studies show that when women’s wages are relative to those of men in dual-income couples, there is a significant reduction in domestic violence. To be self-sufficient is to have bargaining power. It’s to have the ability to exert influence in the relationship. There are public resources designated to help survivors of domestic violence pursue further training and education with the purpose of becoming self-sufficient. Check with social services agencies about these resources.

These recommendations aren’t intended to override the urgency of calling 911 when someone is facing a clear and present danger at home. Let law enforcement personnel figure out how they will bring individuals and families to safety during shelter-in-place situations. Emergency protective orders are being issued even with the courts closed.



Federico Carmona is a trauma therapist for victims of domestic and sexual violence at Peace Over Violence in Los Angeles. He is also an ordained elder in the United Methodist Church. The experience of domestic abuse in his ministry and his own family motivated him to seek specialization in clinical counseling, specifically in trauma, to assist survivors of domestic and sexual abuse and violence to reclaim their identity, peace, and lives with dignity and purpose. Contact him at federico@peaceoverviolence.org.



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

How do counselors support clients during the coronavirus pandemic?

By Yoon Suh Moh and Katharine Sperandio April 9, 2020

It is impossible to deny the extraordinary societal impact of the outbreak of the novel coronavirus, severe acute respiratory syndrome 2 (SARS-Cov-2). All of us are bombarded daily with messages and information related to the pandemic. As this virus garners heightened attention from the media, individuals may have difficulty delineating between misinformation and accurate information about the illness.

We are not writing this article to perpetuate increased fear among the counseling community regarding the spread of the novel coronavirus, but rather to:

  • Provide resources helpful for staying informed about the impact of COVID-19, which is a disease caused by SARS-Cov-2
  • Inform counseling professionals about how they can support clients affected by the virus and its societal impact

What does this outbreak mean to our clients?

It is crucial to understand the social ramifications perpetuated by this outbreak so that we can promote optimal care for the clients we serve.

Individuals who identify as East Asian or appear to be of East Asian descent may be susceptible to experiencing elevated levels of stress related to racism and xenophobia generated by misinformation about the virus. The negative impact on affected individuals ranges from financial and emotional to physical. For example, CNN reported that individuals who appear East Asian have fallen victim to verbal and physical attacks triggered by misguided fears of the infection. Additionally, individuals may be quarantined as a result of suspicions that they have been infected, leading to further stress. Clients who are directly impacted by this wave of racism and xenophobia may experience a vulnerability and lack of safety, perpetuating stress- and trauma-related symptoms.

Although the economic impact of this pandemic has since spread throughout the restaurant industry (and other industries), many Chinese establishments, such as restaurants, were among the first to experience a major decline of business even before community mitigation plans were announced. The financial hit on these establishments has been catastrophic for owners and their families. We must be ready to employ the proper interventions and responses to promote clients’ perseverance, resilience and well-being throughout the tensions that plague our society.

There is no doubt that the novel coronavirus poses a major threat to the entire U.S. economy and the health of our nation as a whole, but concerns are more pronounced among certain populations. For instance, the Pew Research Center reported that approximately 65% of Latinx adults say the coronavirus outbreak is a major threat to the health of the U.S. population as a whole, compared with about 47% of the general public. The same source reports that the outbreak has the potential to hit many of the nation’s nearly 60 million Latinos/as particularly hard. This is in part because a significant percentage of these individuals work in leisure, hospitality and other service industries and have less likelihood of having health insurance.

Of course, many individuals in the general public are fearful (or may become fearful) of contracting the virus. The anticipation of the potential long-term effects of the virus can trigger individual fear and stress-based responses. In addition, an array of compounding or simultaneous stressors can negatively affect individuals’ stress response systems in a chronic manner, meaning that there is no break to return to a healthy physiological state and functioning. These compounding or simultaneous stressors may include:

  • Uncertainty about what might happen next to one’s life and health
  • The exponential curve of virus-confirmed cases and deaths in the nation as reported in the media
  • No access or difficulty in accessing health benefits
  • Financial constraints due to a recent job loss caused by the pandemic

Stress-based responses may be worsened among those who lack resources such as social support.

This brings us to the reality that many states and communities have executed states of emergency, prompting individuals and families to enter into social isolation. Considering the potential negative psychological effects that may be manifested by social isolation, mental health professionals must be ready to intervene and provide support.

Social distancing, taken as a preventive measure to slow the spread of the disease, largely compromises individuals’ daily functioning. People are experiencing disruptions not just in the areas of employment and schooling but also in accessing emotional support from others or even in having regular interactions with others. Individuals who may not have access to technology to virtually stay connected with significant others for emotional support are especially susceptible to social isolation. Social isolation is a risk factor for a number of health-related concerns, including depression.

As the virus continues to ravage communities around the world, it is also important to note that people everywhere are experiencing the loss of their prepandemic normalcy. As a result, many individuals are having feelings associated with grief. Although this pandemic is hypothesized to be temporary, the impact on lives may be much longer term.

Consider that many nonessential businesses have closed their doors, leaving employees without work or a sustainable income to support their families. Most individuals at this point are restrained from engaging in social endeavors such as participating in team sports, attending classes, visiting museums or engaging in other fun-related activities. Most people can no longer meet up with friends or family for regular social events and may feel a sense of loss as their former routines vanish. Social distancing has also called for the cancellation or postponement of important events such as college and high school graduations, preventing new graduates from sharing in a momentous celebration with one another.

Furthermore, the mortality rate associated with COVID-19 continues to rise. People around the world are experiencing the deaths of loved ones and fellow community members. Additionally, family members are assuming the role of caretakers as their vulnerable loved ones fall ill to the virus. As the responsibility to care for loved ones increases, individuals may have to forfeit or abstain from other regular tasks and duties.

Recommendations for counselors

Anxiety management: It is understandable that clients may feel anxious about this situation. Counselors should normalize and validate clients’ fears. Counselors should also talk to clients about factors that they can and cannot control. Some factors that clients can control include getting regular exercise, making plans to meet with friends and loved ones over virtual platforms, determining their exposure to news sources, practicing good personal hygiene, and limiting the time spent in places such as grocery stores where there may be larger crowds.

If clients appear stressed and anxious about the situation, it is a good idea for counselors to help them gain the facts so that clients can accurately determine their risks in collaboration with their health care providers and take reasonable precautions. Additionally, it is ideal to assist clients in developing and enhancing adaptive coping skills, such as grounding techniques or breathing exercises, so that they can effectively manage their anxiety.

Information giving: It is important that counselors stay aware of the latest information available on the COVID-19 outbreak through their local public health authorities and on websites such as those from the Centers for Disease Control and Prevention.

In addition, the World Health Organization (WHO) frequently publishes coronavirus disease situation reports to provide updated information on the outbreak in the world. The WHO website also provides reader-friendly infographics and videos pertaining to protecting yourself and others from getting sick, coping with stress during the pandemic, practicing food safety, and staying healthy while travelling.

Neuroscience News & Research from Technology Networks has provided a short, layperson-friendly video clip titled “What actually happens if you get coronavirus?” that describes how the coronavirus affects the human body.

Counselors should also encourage their clients to stay informed by providing the aforementioned resources.

Culturally responsive service in clinical practice: Counselors can serve as protective and promotive factors when working with individuals who are either directly or indirectly impacted by the coronavirus. Counselors can promote the well-being of clients through the establishment of safety in the therapeutic process and providing them with the opportunity to process the implications of this societal issue. Additionally, counselors can facilitate the process of healing and assist in mediating factors that contribute to individuals’ vulnerability and risk. Therapy can be the catalyst for clients’ adaptability to stressors and adversity brought on by the anticipation of potential consequences from the spread of the virus.

It is crucial that counselors uphold the ethical principles of the profession, including beneficence, nonmaleficence, veracity, justice, fidelity and autonomy, when working with clients. Counselors must be attuned to clients’ well-being and do no harm, as well as treating all individuals fairly and justly. Counselors must normalize and validate clients’ concerns while also providing accurate psychoeducation (not only to our clients but also to the rest of our communities).

Counselors should also be aware that certain ethnic groups, such as those of East Asian descent, may be experiencing additional stressors. President Donald Trump has repeatedly referred to the novel coronavirus as the “Chinese virus” because of its origin in China. We believe such language has contributed to the significant and disproportionate number of verbal and physical attacks on individuals of East Asian descent living in the United States.

We encourage counselors to address these social and societal challenges with these clients, including how such challenges may be affecting their well-being. Counselors should be ready to advocate and provide a voice for individuals who may be marginalized and oppressed due to the societal impact of the outbreak.


Our hope is that this article will give professional counselors and counseling students an opportunity to educate the community with accurate information regarding the COVID-19 pandemic. Furthermore, we hope that professional counselors are informed and effectively equipped to provide support for clients who are affected by the virus and its societal impact. Finally, we encourage all counseling professionals to partake in preventative measures against further expansion of COVID-19 in the nation. After all, prevention is one of the philosophical cornerstones of the counseling profession.



For more on this topic, check out the article “Coping with the (ongoing) stress of COVID-19” from Counseling Today‘s June magazine.



Yoon Suh Moh is an assistant professor in the community and trauma counseling program at Thomas Jefferson University in Philadelphia. As a licensed professional counselor, national certified counselor and certified rehabilitation counselor, her primary areas of clinical and research interest include the effects of chronic or toxic stress on mental illness, wellness of counseling professionals, and integrative, healing-centered approaches such as neurocounseling. Contact her at yoonsuh.moh@jefferson.edu.

Katharine Sperandio is an assistant professor in the community and trauma counseling program at Thomas Jefferson University. Her main areas of focus include addictions counseling, counselor education, addictions and family systems, and social justice issues in counseling. Contact her at Katharine.Sperandio@jefferson.edu.



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.

Crossing the finish line: Boston returns to the scene of last year’s trauma

By Bethany Bray April 21, 2014


A temporary memorial, where people hung running shoes, flowers, notes and other mementos, went up at the Boston Marathon finish line within hours of last year’s bombing. Photo courtesy of Michael Kocet

The Boston Marathon’s 26.2 mile course can be a metaphor for what the city has been through over the past year: a long, winding stretch of ups and downs, heartbreak and triumph.

Today, April 21, thousands of runners return to finish the race that was halted unexpectedly and tragically one year ago, when two bombs went off at the finish line, killing three people and injuring more than 260.

Returning to the scene of last year’s trauma will have many mental health implications, not only for the runners but the spectators, local residents and those watching on television, far and wide.

Boston’s Public Health Commission has organized a series of free, drop-in counseling sessions this month for anyone feeling anxious about the one-year anniversary.

While hundreds were injured at last years marathon, the invisible injuries go far beyond those who were physically at the race, says Anthony Centore, a licensed mental health counselor (LMHC) and licensed professional counselor (LPC) with a practice in Boston.

“It’s a difficult week, but the people of Boston are tough. They were tough right after the bombing, and they’re tough now,” says Centore, an American Counseling Association (ACA) member. “This week, some people are angry, many are mourning and others are reflecting on the challenges they’ve overcome over the last year. There is a sense of unity here, and also a desire to show the world that Bostonians won’t be defeated by a terrorist act.”

Several days after last year’s marathon, a large portion of Boston (an area that is home to nearly one million people) was put into a “shelter in place” lockdown as the authorities conducted a massive manhunt for the bombing suspects. Neighborhoods were jolted awake as the suspects threw explosives and fired at police from their vehicle.

In the wake of this extended trauma, Centore’s practice offered free counseling “to anyone who needed it” after last year’s marathon, he says.

“Three persons were killed and an estimated 264 others were physically injured during the bombing. However, the ripple effect, of course, goes much farther,” says Centore. “The physical and psychological recovery of some of the injured may take years. Also, some persons near the finish line were physically unharmed but traumatized by what occurred. Families have been working to find a new normal, and put their lives back together. And there are others who have experienced a secondary trauma, or for whom the bombing triggered a past trauma.”

Boston-area LMHC Michael Kocet uses the words resilience, solidarity and hopeful to describe the city’s emotions through the past year.

Kocet, an ACA member and associate professor in the department of counselor education at Bridgewater State University, says he’s seen “a lot of selflessness” and “boundless compassion” in the wake of last years trauma.

A temporary memorial, where people hung running shoes, flowers, notes and other mementos, went up at the finish line within hours of the bombing. There are still signs with the “Boston Strong” motto in shop windows everywhere you look, Kocet says.

“It’s not something, collectively, you get over,” says Kocet. “… Boston has a reputation for having a tough exterior, [and] we’re an incredibly resilient city.”

Kocet and Centore both said Boston’s ongoing recovery – both physical and psychological — is a testament to the strength of the human spirit.

“I think [the recovery] is a testament to how resilient the human spirit can be, and to how strong the people of Boston are,” says Centore.


ACA Member Michael Kocet ran the BAA 5K this month. Photo courtesy of Michael Kocet

Kocet, who recently started running, ran the Boston Athletic Association’s 5K on April 19, which is the same organization that manages the marathon.

Through running, Kocet says he’s come to realize the emotional and psychological connections people make through running – from the cause they’re running for (often fundraising for a charity) to the competition against themselves, to run a faster time.

“I can appreciate how races play a special role in people’s lives,” he says. “The races people chose to run can carry a deep meaning, an emotional connection.”

The marathon can be a metaphor for life, says Kocet. Not only does is it require personal determination, resilience and goal setting, but the need for encouragement and support from spectators on the sidelines.

“Everybody has a journey that they’re running (and) striving toward goals,” he says.

“Watching people cross the (Boston Marathon) finish line, it’s emotional, even as a spectator. I equate it as kind of a spiritual experience, a personal accomplishment,” he says. “… Crossing that finish line (this year) will be even more sweet because of everything that has happened.”




Related links


WBUR interview with the Boston Public Health Commission’s executive director on the city’s residual trauma and free counseling sessions



Counseling Today article from one year ago, “The mental health effects of sheltering in place”



Q+A with two Boston University professors: What impact did the Boston Marathon bombing have on children?



The Substance Abuse & Mental Health Services Administration (SAMHSA) offers a free downloadable emergency mental health and trauma kit




Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org


Follow Counseling Today on Twitter @ACA_CTonline

The mental health effects of sheltering-in-place

By Stephanie Dailey and Tara S. Jungersen June 13, 2013

(Photo: Wikimedia Commons)

(Photo: Wikimedia Commons)

In every emergency event or disaster, there are two basic options for the public: evacuate or shelter-in-place (SIP). Historically, evacuation has received more attention by emergency response authorities largely due to mandated fire drills, natural and human-caused disaster planning, and recent tragedies such as Hurricane Sandy in 2012 and Hurricane Irene in 2011. However, in the event that evacuation is not feasible, such as during the search for the Boston Marathon bombing suspects on April 19, increased consideration is given to SIP as an effective emergency response measure.

Counselors working in an emergency or disaster setting must be aware of the implications of a SIP order to effectively assist individuals, families, emergency personnel, and communities.

What is SIP?

According to the Department of Homeland Security, some emergency situations make going outdoors dangerous because leaving the area might take too long or put occupants in harm’s way. In such cases, it may be safer for occupants to stay indoors. This is especially true in large metropolitan areas where a mass evacuation can result in dangerous gridlock rather than serving as a protective action strategy. SIP can occur in a variety of emergency situations, ranging from the detonation of radiological dispersal devices (dirty bombs), toxic explosions and chemical spills to much more common emergencies such as electrical blackouts and snowstorms.

During an SIP emergency, individuals must remain indoors, whether they are at home, work, school, shopping, in a place of worship, at a friend’s house or elsewhere. A SIP response can last from a few hours to several days and may require individuals to be separated from family members.

Depending on the type of emergency that precipitates the SIP, individuals may have varying access to supplies, materials and information. For example, if a dirty bomb is detonated in an area, groups of individuals may have to retreat to a single room and tape the windows, doors and air vents shut to prevent exposure to radiation. During a storm, individuals may be without electricity and heat. In both scenarios, individuals without battery-powered radios may be effectively cut off from status updates and public messages about the disaster event. This can result in fear, confusion and anger.

 SIP during the Boston Marathon bombing manhunt

On April 19 at 5:13 a.m., Massachusetts Gov. Deval Patrick and Boston Police Commissioner Edward Davis suggested a SIP order for residents in the communities of Watertown, Cambridge, Waltham, Newton, Belmont and Boston, while police and emergency personnel searched for suspects in the Boston Marathon bombings. For 12 and a half hours, residents were instructed to remain indoors while authorities conducted an areawide manhunt for the individuals believed to be responsible for detonating two bombs near the marathon finish line four days earlier.

During this time, individuals were instructed to lock their doors and to open them only for a properly credentialed police authority. Additionally, several media outlets reported the possibility that the perpetrators had planted additional bombs throughout the city and that a safety clearance was needed to protect the public. As a result, a metropolitan area of 4.5 million people, the 10th largest in the United States, came to a halt as public services, transportation and businesses all shut down for the day.

 Why do counselors need to know about SIP?

Emergency managers and disaster response personnel express concern about the challenge of compliance with an SIP order. In a study of the public’s knowledge of SIP, Lasker, Hunter and Francis (2007) found that only 59 percent of the U.S. population would shelter inside a building other than their own home during an emergency. Furthermore, the emotional effects of this voluntary confinement strategy have not been widely explored. Analogue research as well as qualitative inquiries about SIP behavior have discovered that individuals worry about experiencing emotional distress, knowing what to do if others becoming unruly or violent, and about how much to trust authorities (Dailey & Kaplan, under review; Lasker et al., 2007).

Several factors can determine whether people comply with a SIP order. Practical issues such as loss of income, lack of supplies or lack of adequate shelter may affect an individual’s decision to shelter-in-place. Some may have caretaking obligations of family members or children. Others may struggle with the emotional effects of virtual confinement, separation from family members and the group dynamics that evolve when sheltering with coworkers, extended family members or strangers. Another issue relates to the event that set the SIP order in motion in the first place. Individuals evaluate the credibility of the source of the SIP order, the perception of actual danger and the degree of perceived personal relevance of the event. Previous disaster or trauma experience can also affect this perception.

What practical strategies can counselors use?

Counselors may be involved in various roles before, during and after a SIP order. Before a SIP, counselors can encourage their clients, organizations and/or schools to have appropriate prevention and preparation measures in place. Counselors can also ensure that persons have a resource list, such as the American Red Cross “Coping with Shelter-in-Place Emergencies” fact sheet. Counselors can also make sure that coworkers, friends and family members discuss the SIP plan ahead of time. Additionally, counselors can suggest that persons and organizations have a supplies kit stocked in case of a SIP emergency. Examples of needed supplies include bottled water, medications, first aid supplies, quiet games, books, playing cards, disposable wipes and nonperishable foods. Similar kits are used for emergency preparedness for hurricanes and other natural disasters.

During a SIP emergency, counselors may find themselves sheltering with several individuals. In this situation, a counselor’s knowledge of group dynamics and disaster responses can come in handy. Depending on the makeup of the group involved, some stages of forming, storming, norming, performing and adjourning may occur as groups develop various levels of cohesion. Some group members may unintentionally antagonize the group during the stressful situation by panicking. This situation would require individual attention or redirection away from talking about the emergency at hand. Other persons could be engaged in facilitative roles to assist other persons who may be struggling with sadness, fear or worry. Counselors may also utilize disaster interventions to help ground people in the here and now during a chaotic event. Finally, counselors should work to quell rumors, which can escalate an already tense situation. Counselors should encourage persons to deal only with confirmed facts and realize that information obtained during a disaster is fluid and requires substantiation.

After the “all clear” at the conclusion of the SIP, counselors must focus on the resilience and posttraumatic growth that can occur after a disaster or emergency. The outcome of the crisis event and the length of the SIP may affect individuals’ abilities to integrate back into their normal routines. However, studies show that most people do not have any long-term negative effects from the SIP experience itself. Counselors may be called upon by emergency management personnel to implement post-disaster interventions, such as Psychological First Aid, to further assist in the postvention.


For more information, see the following resources:

Click on the images below to see an American Red Cross fact sheet on shelter-in-place (2 pages):








Stephanie Dailey (Argosy University/Washington, D.C.) and Tara S. Jungersen (Nova Southeastern University) are members of the ACA Trauma Interest Network.