Tag Archives: stress & anxiety

Finding love in a ‘swipe left’ universe

By Bethany Bray November 28, 2018

When it comes to dating, it’s often said there are plenty of fish in the sea. But when you’re dangling a fishing pole in the seemingly vast ocean of online dating and not getting many nibbles, it can leave you with a seasick feeling. Or perhaps you’ve heard tales of other people connecting with really nice fish, but whenever you cast a line, all you seem to reel in are sharks and slippery eels.

Online dating can be a great way for people to meet those who are outside of their usual social circles and connect with potential partners whom they might never have crossed paths with otherwise. At the same time, getting to “happily ever after” can be an emotionally charged experience fraught with rejection and anxiety-provoking scenarios.

As with conventional dating, online dating carries with it the inherent risks of having bad dates and encountering hurtful behavior. But with online dating, the always-on nature of the technology allows users (perhaps encourages users is even more accurate) to check, recheck and overanalyze whether a potential match has viewed their profile, responded to a message or blocked the match entirely.

Yes, online dating carries the potential for disappointment and anxiety, acknowledges Rachel Dack, a licensed clinical professional counselor with a private practice in Bethesda, Maryland, who specializes in helping clients with dating, relationship and intimacy issues. However, she believes that online dating is a risk worth taking — if approached in a healthy way.

There are “normal highs and lows associated with online dating, and, unfortunately, many of those situations are unavoidable. … It’s helpful for counselors to understand that, oftentimes, online dating takes years [before finding the right relationship]. Helping clients with patience and setting realistic expectations is key,” says Dack, who writes and contributes relationship pointers for eHarmony and DatingAdvice.com. “Often, social media and pop culture can offer an unrealistic picture of it. It’s helpful to reframe a client’s view. It’s really important to normalize the online dating experience, including the good, the bad and the ugly.”

Fifteen percent of U.S. adults have used an online dating website or app, according to data from the Pew Research Center. Since 2013, usage of online dating has nearly tripled among adults ages 18-24 and doubled among those ages 55-64.

As online dating grows more widespread, it is also becoming more socially accepted. Pew reports that nearly half of all Americans know someone who uses online dating or has met a romantic partner online.

Online dating offers users opportunities to enter the dating pool at their own pace, pursuing and accepting as many messages and matches as they choose, notes Dack, a member of the American Counseling Association.

“It can be overwhelming to have as many choices as we have online, but at the same time, it’s an amazing opportunity to meet people,” she says. “Online dating can be a powerful tool for clients who are more shy or introverted and unlikely to approach new people in public. There can be a large sense of comfort found in starting communication [with a potential match] on a phone or computer and setting the pace for what communication looks like. You can get to know someone slowly, over time, instead of trying to approach someone and make decisions right away.”

 

Getting up to speed

The online dating market is a crowded one, with dozens of apps and programs available. Some require payment to join, and some are free. Some match users on the basis of sophisticated algorithms, whereas others allow users to “swipe” through profiles and choose only those that appeal to them. Certain apps are designed to allow only female users to make the first move of contacting another user. And yet others cater to LGBTQ consumers, those looking for matches of a certain religious faith or other demographics.

Although it isn’t necessary for counselors to know the nuances between all of these options, they should have a basic understanding of what online dating is and how it works so they can connect with clients who present with issues related to online dating in therapy sessions, says Mark J. Taliancich, a licensed professional counselor supervisor in New Orleans whose doctoral dissertation was on online dating. He suggests that counselors search for information online to bring themselves up to speed. Although scholarly research on the topic is limited, especially as it pertains to online dating’s connection to mental health, he says an internet search will yield plenty of consumer-focused reviews and news articles that detail the online dating experience and the pros and cons of different platforms. Should clients raise an issue specific to the online dating app they are using, Taliancich suggests having them talk through their experience in session.

Kathleen Smith, a licensed professional counselor in Washington, D.C., agrees. She says counselors should engage these clients by asking why they chose a particular app or platform and which features appealed to them. “It’s not the client’s job to teach you how it works, but also don’t just pretend that you understand,” Smith says. “Just having a basic knowledge can be important. [Online dating] is not just exchanging messages. Know which are the most-used apps and their features.”

Taliancich also stresses that counselors should drop any outdated or stereotypical assumptions they might harbor, such as the misconception that online dating is used only by people who are desperate or awkward and can’t find dates any other way.

“It’s similar to a multicultural issue, or working with a client who has an aspect of their culture that’s not familiar [to the counselor]. It requires doing a little research, a little homework. Realize that there’s a different process to each app,” says Taliancich, the clinical director of counseling solutions for the Catholic Charities Archdiocese of New Orleans. “Don’t go off of assumptions or things you’ve heard. It’s really easy to say ‘online dating is dangerous.’ But when you dig down into it, it’s as dangerous as traditional dating. … Two common criticisms of online dating are that it’s dangerous and people lie [about themselves]. I would argue [those things] can be true of traditional dating just as much.”

 

Diving in

The nature of online dating can exacerbate mental health issues, including struggles with anxiety, self-esteem and setting boundaries. For some clients, it can also dredge up feelings related to past experiences with rejection, abandonment, loss or trauma. For example, a lack of replies to messages could be especially damaging to a client who has issues with self-worth or rejection. Similarly, selecting photos for an online profile can bring up issues for those who struggle with their body image.

“Dating can be a very triggering and uncomfortable experience based on [individuals’] personal mindset about themselves,” Dack says. “A lot of negative feelings [about yourself] can be reinforced through online dating.” At the same time, she adds, “If you’re working to be your best, that’s what you will attract. [Clients’] attitudes about themselves and connecting to others are a major factor in meeting others and the dating process.”

Counselors can help clients work through past issues that spill over into their online dating experiences and prepare them for the challenges that can be a natural part of dating, Dack says. She emphasizes the need to offer both a compassionate and realistic approach.

“With rejection, reinforce that it’s a normal part of the dating experience and probably has nothing to do with them. But [for some clients], their past is going to make them believe that it has everything to do with them,” Dack says. “Hold space for the client to feel their emotions about the past and really grieve and work through it.”

“Online dating is setting you up to get rejected more frequently — remember that,” she adds. “It’s really hard for us to grasp the concept that not everybody is supposed to like us or will like us, and that comes [up] with online dating.”

Smith says she has similar conversations with her clients, the majority of whom are women in their 20s and 30s. She counsels clients that it’s more important to focus on themselves and becoming the person they want to be rather than on what they think a potential match might be looking for.

“The ability to step back and remember yourself versus being anxious about how to make a person not break up with you, that puts the focus on things that are easier and calmer,” says Smith, whose doctoral dissertation was on cellphone use and anxiety. “Help people recognize that dating, especially online dating, is an anxious process. It’s very risky, and you can only control 50 percent of the process. If your anxiety spikes during the process, it doesn’t necessarily mean something is wrong. You’re putting yourself out there and engaging with someone you don’t know who is allowed to reject you. It’s what you do to manage it and respond to it [that matters].”

 

Navigating the ups and downs

Counselors can help clients maintain a healthy perspective and remain true to themselves even as they navigate the sometimes-choppy waters of online dating. The following takeaways can provide some guidance.

Get to the why: One of the most helpful questions counselors can ask clients about online dating is why they chose to sign up in the first place. The answer can provide insights into the person’s goals, intent and motivations, says Taliancich, an adjunct professor in the master’s counseling program at the University of Holy Cross in New Orleans.

“It’s entirely possible to dive into online dating and never have to spend a night alone,” he says. “People can go on four, five or six dates a week, for whatever motivation. But it can be a way to escape something or not deal with another issue. There is a range of motivations, just as with traditional dating.”

At the same time, Taliancich stresses, counselors shouldn’t assume that every client makes a conscious choice to date online versus pursuing more traditional methods. For younger, more tech-savvy clients in particular, online dating may be the more accepted way to meet people. Others may simply feel it is the best option open to them for any number of reasons, such as there being no eligible matches in their immediate social circles.

Set a good pace: “Helping people get the right pace is a conversation I often have [with clients],” Smith says. “Make sure they focus on work and friends and the life they had before they started to date. Clients often focus on whether a relationship will work or not, but breaking it down into manageable steps can be helpful. People tend to be so terrified that they don’t [date] or are so obsessed that they turn dating into a full-time job and get burned out and frustrated. I have conversations with clients about taking breaks when they need to. There’s so much data, you can spend forever looking at it and go on tons of dates. It can be very overwhelming for people when they see so many potential matches and they forget themselves and what they’re looking for.”

Conduct a time check: It’s important to ask clients how much time they’re spending on online dating apps, Taliancich notes, because in many cases, they may not even realize the degree to which it is eating into other aspects of their life, such as schoolwork or connecting with friends. He explains that the apps draw people in with behavioral “rewards” for staying engaged, such as notifying them that a match has viewed their profile or the app has developed a batch of new matches for them to view.

Smith works with clients to monitor and create boundaries for the amount of time they spend focusing on online dating. This can be especially important for clients whose anxiety fluctuates according to the number of responses and attention they receive from matches. She recommends asking clients, “When does [online dating] get in the way? How can you direct yourself away from that when you need to?”

It can also be helpful to remind clients that they can turn their app notifications off entirely or change the settings so they don’t receive messages that are particularly triggering, such as when a match looks at their profile or blocks them, Smith notes.

“How [a client] engages with the apps and technology is such a good marker for their anxiety,” Smith says. “Ask them questions: ‘How often do you look at the app?’ Gauge how much of their time this is taking up. Are they dating reactively or thoughtfully? People might not own up to that at first, but if you ask, it may be surprising how much they are focusing on it.”

Know your client: Clients who have struggled with anxious or obsessive behaviors in the past may find it difficult to resist checking and rechecking a dating app for messages or new matches. A counselor who knows that a client is sensitive to rejection can help prepare that client to manage his or her reaction when the inevitable happens.

“If it’s someone you’ve been working with, you’ll know how likely they are to be compulsive or sucked into that experience,” says Taliancich, who met his wife through online dating. “People who feel invested by chatting with someone, they can take it a lot harder when they don’t get a response or [the match] stops replying. It feels a lot worse for them because the rejection feels a lot stronger — feeling that stab, over and over. Whereas people who don’t feel as invested in that initial part tend to navigate it a little easier because it doesn’t feel as much like a personal affront [to them].”

Similarly, Smith notes, clients who have a history of relying on relationships to regulate their moods may find it easy to fall into bad habits with online dating. “Your mood will ascend and descend based on dates, inevitably, but if your sense of self is coming from dating, it will be worse,” she says. “Have the client ask themselves, ‘If I’m not paying attention, what might happen? What do I need to be aware of, be mindful of? How can I be my best self?’”

Celebrate goals, not boyfriends or girlfriends: Clients may assume that success in online dating equates to finding a steady relationship. The reality, though, is that it simply won’t happen for everyone. Instead, Smith urges her clients to learn from each interaction and to celebrate each goal they reach.

“There’s also successes such as being able to go out on a date when they haven’t in a really long time. Celebrate that. Or have the goal that I’m going to do this [go on a date] and be OK the next day. And that’s great,” Smith says. “Having those clarifying experiences, even if they’re breakups, I would see as a victory. Next time, things will go more smoothly.”

Turn “failure” on its head: Smith recalls one client who began dating a match whom she really liked. However, he wouldn’t respond to her messages consistently, which “was driving her up the wall,” Smith says. Eventually, the client was able to talk calmly to him and explain what she needed, and the pair came to the mutual conclusion that the relationship wasn’t going to work out. Although some might have considered that a failure, Smith helped the client to see it as a success: She had learned for next time what she wanted and needed in a match.

Likewise, counselors can help their clients reframe some of the things they experience in online dating. “Everyone in life has to learn that rejection and disappointment is inevitable. You learn that in different ways, and dating is one way,” Smith explains. “If you can find humor in it, that can help. Set a goal of going on one terrible date or being rejected a couple of times. It can help to laugh at it a little. It makes it not so intimidating. You don’t necessarily have to get better at rejection, but know that it’s not a failure. Knowing that you can only control 50 percent of the process, it’s more about managing yourself than trying to control another person.”

Stay true to yourself: Smith sometimes suggests that clients create a list of “guiding principles” they can focus on during dating and refer back to when they start to feel anxious. The principles can be as simple as “be honest” or “be kind.” Other clients may need to add more specific benchmarks, such as, “Don’t check my dating app more than once each day.”

As Smith explains, the guiding principles can offer reassurance whenever clients have a bad date or other negative experience. “Focusing on what they can control in the dating process can help them calm down and feel less anxious,” she says. “Measure progress not on whether a person liked [you], but ‘Was I the person I wanted to be? Was I myself?’ If you’re doing that, then you’re doing what you’re supposed to be doing.”

Similarly, Dack works with clients, particularly those who struggle with anxiety, to create predate rituals that can help them focus on goals they have set. The rituals — perhaps listening to a favorite music playlist or repeating a positive affirmation — help them prepare and quiet down their predate jitters, she says.

Use role-play: Dack suggests that counselors use role-play exercises in session with clients to prepare them for interacting on dates. She asks clients some of the sensitive questions that might come up (for example, “How long was your longest relationship?”) and gives them feedback on their responses. This can help teach clients what levels of self-disclosure are appropriate when meeting a potential match and how to express themselves in healthy, genuine ways, she says. It can be particularly beneficial for clients who struggle with vulnerability or who view being vulnerable as a weakness.

Dack notes that questions about past relationships — or a lack thereof — can dredge up feelings of shame for those who view themselves as inexperienced. “We want to help them feel vulnerable and authentic while being confident about what they have to offer. With men in particular, there are societal expectations and poor dating advice telling them to portray themselves as super successful, masculine or strong. Sometimes, this can come off as sales-y or disingenuous,” she says. “I encourage my clients to be more open and real.”

“Remind clients that it’s important to be authentic and truthful, but there are layers to sharing,” she continues. “It’s important to share at an appropriate pace. [Find] balance in disclosure. Also, reading your date’s body language and responses is an important skill. My approach is very direct and feedback-oriented so [clients] can practice self-disclosure in a healthy way and learn what comes off as fake or manipulative.”

Be mature rather than anxious: Smith uses the word “mature” with clients to describe behaviors and reactions that are the opposite of anxious. This often comes up in conversations about online dating, she says. For example, when a match doesn’t text after a date or respond to messages right away, the client might be tempted to react in anxious ways: checking and rechecking the app, obsessing over the date’s social media accounts or barraging the person with follow-up messages.

With clients who find themselves overthinking aspects of the dating process, Smith says it can be helpful for a counselor to ask, “How would you know you are doing this as maturely as possible? How would you interact with this differently than you are now? What’s the mature way? What’s the anxious way, and how do you know the difference between the two?”

“Believe it or not,” she says, “there is a mature way to interact with these apps. The word ‘maturity’ helps people figure out a way to not let it take over their life or not make them want to throw their phone across the room. The more maturely you engage with it, the better the chance that you will match with someone who is mature and handling it well.”

Interrupt the negative spiral: Clients may approach online dating with negative assumptions that it won’t work out, especially if they harbor feelings of self-doubt or shame associated with being single, Dack says. Those feelings can be exacerbated when clients experience rejection or when they aren’t getting many responses from potential matches.

“They may be operating on a narrative that they’re not worthy,” Dack explains. “It can be very challenging to hold on to the belief that love will happen for you. That can be a very challenging belief to sit with. Feeling good about yourself and believing you have something to offer is a key part of dating success. But if it’s not going well, it’s hard to feel good about yourself. They may take the ups and downs personally.”

Counselors can equip clients to quell this negative cycle by teaching them how to use positive self-talk, Dack suggests. The intervention can help clients overwrite the negative thoughts and messaging that “can get particularly loud with bad dating experiences,” she says.

Dack works with clients to create positive affirmations that they can refer to whenever they’re feeling low. For instance, she says, counselors can help clients replace thoughts such as “I’m going to end up alone” or “I’m doomed in the love department” with messages such as “I am open and ready for love,” “I am committed to connecting with others,” “I am worthy of the type of relationship I’m looking for” and “I choose to accept and grow from my challenging relationships and breakups.”

In session, counselors can listen to clients’ language and point out cognitive distortions to help steer them away from negative thought patterns. For example, a client might remark “My dating life never goes right, so why bother?”

“They’re in an internal conflict because they really do want to date and find a satisfying relationship. It’s important to change any self-defeating narratives because these beliefs are going to make them feel worse,” Dack says. “Offer a realistic perspective while trying to step out of their self-narrative. If they say, ‘All men are jerks,’ break that down [with the client]. Look for exceptions and positives that can foster hope and clear out mental blocks.”

Helping clients focus on what they are able to control in the experience can also shift thinking away from the negative, Dack adds. For instance, they are not able to control whether a match responds to a message. However, they can pick and choose which dating apps they use,
what they say about themselves in their online dating profile and other aspects
of the process.

Accept some anxiety as natural: Counselors who understand online dating can help clients set realistic expectations about the process and prepare them for the reality that meeting new people and opening themselves to rejection is bound to involve some measure of anxiety, Dack says.

“With anxious clients, it’s important for counselors to understand that dating is basically exposing them to constant anxiety — everything from waiting to hear back from a date to showing up for a date and figuring out the frequency of communication,” Dack says. “It can be mentally exhausting, but it can also be really good. It’s hard, but it’s worth it. The anxiety about it is natural to living a full life. Anxiety is normal in dating, and it doesn’t have to keep you from dating. The more skill and intention that clients bring to their dating life, the better it goes.”

 

****

 

Contact the counselors interviewed for this article:

 

****

 

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

Letters to the editor: ct@counseling.org

 

****

 

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.

Supporting clients through the anxiety and exhaustion of food allergies

By Bethany Bray November 27, 2018

The diagnosis of a food allergy is life-changing, not just for the individual but for those who love and live with that person. In addition to avoiding exposure to certain foods, the condition requires that these families and individuals explain, over and over again, the seriousness of the allergy at schools, restaurants, social gatherings, workplaces, daycare facilities and countless other places.

It can all be exhausting, says Tamara Hubbard, a licensed clinical professional counselor whose son was diagnosed with a peanut allergy six years ago. Families receiving a new allergy diagnosis face steep learning curves that can cause them to worry and to overthink every detail of what their child or other loved one eats or might be exposed to.

“It’s almost like Russian roulette. You don’t know when an [allergic] reaction will happen, even when you take precautions,” Hubbard explains. “There’s a constant level of fear and anxiety at all times in the background that parents and caregivers need help managing.”

Food allergies affect an estimated 4 to 6 percent of children in the United States, according to the U.S. Centers for Disease Control and Prevention. Between 1997 and 2007, food allergies increased 18 percent among American children and adolescents younger than 18.

A food allergy reaction sends someone in the United States to the emergency room every three minutes, reports the nonprofit organization Food Allergy Research & Education (FARE).

Counselors can help clients work through the anxiety and other mental health issues that food allergies sometimes exacerbate, but they can also be a source of support simply by serving as a listening ear. Clients may come to a counselor’s office worn out from the self-advocacy and constant vigilance that a food allergy requires, explains Hubbard, who has a private practice in the suburbs of Chicago that specializes in supporting clients (and their families) with food allergies.

With food allergies, there is sometimes “a constant feeling of having to fight in every conversation to get your point across,” she says. “Just being an empathic, listening ear [as a counselor] and wanting to learn, that makes a huge difference in their anxiety level and ability to release tension.”

At the same time, counselors should research and learn about food allergies to become a competent support to clients, Hubbard emphasizes. For example, they should know that an intolerance or sensitivity to a food is very different from a diagnosed allergy.

With a food allergy, the immune system views the allergen — for example, wheat, shellfish or peanuts — as an invader and overreacts whenever it enters the body. Someone who ingests a food that he or she has an intolerance or sensitivity to will experience discomfort but not the potentially life-threatening reaction that comes with an allergy, Hubbard explains.

Counselors who understand the biological and mental health implications of food allergies can help these clients to live fuller lives, Hubbard says. Although the most important thing counselors can do is learn about and understand food allergies, exercising compassion is also essential, she says.

“Sometimes, even medical professionals aren’t good at that part. They send [people] off with an EpiPen and say, ‘Come back in six months.’ In a perfect world, they would send them off with a list of resources for mental health and wellness,” says Hubbard, an American Counseling Association member. “Counselors can play a very important part to fill in that gap, even if it’s just an empathic ear. That is incredibly therapeutic in itself.”

 

Tempering the uncertainty

The anxiety that families and individuals with food allergies often experience is more complex than simply worrying about possible exposure to an allergen, Hubbard says. Anxiety can spike over everything from sending a child to school and worrying that the staff won’t follow allergy-safe protocols to second-guessing whether a food product might contain nuts, even when the label says it doesn’t.

In the United States, companies are required to note on food labeling whether a product contains one or more of the eight most common allergens. These potential allergens are:

  • Milk/dairy
  • Eggs
  • Fin fish (e.g., salmon, flounder, cod)
  • Shellfish (e.g., crab, lobster, shrimp)
  • Tree nuts (e.g., almonds, walnuts, pecans)
  • Peanuts
  • Wheat
  • Soybeans

However, U.S. companies are not required to disclose whether a product is made in a facility or on equipment that is or was exposed to those eight allergens, Hubbard notes.

With that in mind, navigating grocery stores, restaurants and social gatherings involving food can be anxiety-provoking for those with food allergies — and especially for newly diagnosed families, Hubbard says. Some parents react by restricting their child’s activity to reduce the risk of exposure.

Allergy diagnoses are sometimes given after a person has experienced one initial anaphylactic reaction. This can create uncertainty concerning how much of the allergen is too much. For example, is it OK to be near someone else who is eating the food to which the person is allergic?

“There is fear of the unknown: ‘How much of the allergen will it take for my child to react?’ There are different layers to the anxiety, and it’s important [for counselors] to understand each layer,” Hubbard says. “Also, the anxiety affects each member of the family; they will all feel it. There’s a lot to unpack when you are assessing a client who is dealing with food allergies.”

Counselors who understand the complexity of the issue can help clients find balance and equip them with tools to manage the anxiety, Hubbard notes.

“Ultimately, the goal is to help the client — whether it’s the allergic person themselves or a caregiver — assess the risk for every situation they’re going to be in. Is their anxiety based on fact or emotion? We can tell ourselves that everything is unsafe, or we can navigate [the risk] and take precautions,” she says.

 

Finding balance

There is a balance between living in fear and frustration because of food allergies and still enjoying a good quality of life, Hubbard stresses. “Understand that in many cases, when someone is newly diagnosed, especially if it’s a young child, the person or family may be very overwhelmed initially,” she says, “as there can be a steep learning curve when your lifestyle needs to suddenly change due to a food allergy diagnosis. Some people navigate this well, while others need support and guidance. I typically encourage people to remember that it will take time to get used to the diagnosis and gain all of the necessary knowledge to live a well-balanced life between food allergy fears and empowerment. I also encourage those who are newly diagnosed to learn the basics at first and, over time, as they feel ready, branch out to other related food allergy topics, such as potential treatments, research and advocacy.”

Here are some tips for counselors to keep in mind related to food allergies:

> Prepare for an emotional roller-coaster: Food allergies can be life-threatening, so it’s understandable when individuals (or their families) experience strong emotions such as fear, sadness, anger or guilt connected to the diagnosis. Of course, these emotions can eventually lead to becoming overwhelmed or burning out, Hubbard says.

“If a child has a [allergic] reaction, the parents can feel strong emotions of ‘what did I do wrong?’ At the same time, they could have done everything 100 percent right,” Hubbard says. “The reality is that it’s a big deal, but that doesn’t mean it has to be a … crisis every day.”

Equipping clients with coping mechanisms will not only help them manage their own anxiety and strong emotions but will also keep them from transferring those feelings to the child or family member with the allergy, Hubbard says.

Counselors can also help clients work through their feelings of loss concerning what their life (or their child’s life) might have been like without the limitations of a food allergy. For example, they may yearn to eat at a restaurant without having to ask about the establishment’s allergy protocols or to eat lunch with friends in the school cafeteria instead of sitting at a separate table or worrying about what foods they could be exposed to.

“These children [with food allergies] have to grow up a little quicker in some respects. They have to learn to speak up for themselves and make decisions,” Hubbard says. “It’s about managing the feelings and finding ways to help them empower themselves and advocate to come through with some balance.”

> Move toward acceptance: One of the most important things counselors can do is help clients reach acceptance of the food allergy diagnosis, Hubbard says. This can have similarities to grief work, including helping clients come to terms with the fact that they can’t change the situation, she explains. Narrative therapy can assist clients in reframing their feelings and taking control of their story.

Role-play can be beneficial for clients of all ages because it helps them learn to navigate their feelings and the language they will need to use to advocate for themselves. (For example, how will they explain that they can’t eat the cake at an upcoming birthday party?) Hubbard says she also finds play therapy, mindfulness and cognitive behavior therapy helpful for clients with food allergies.

Above all, she says, counselors should make sure their approaches are tailored to and appropriate for the individual client. “For kids, it’s not appropriate to talk about the risk of death [involved with food allergies], but coping with their feelings and worry is appropriate,” she notes.

Counselors can also model acceptance for clients in session, Hubbard adds. It can be a relief to find that “they don’t have to walk into a session defending themselves,” she says. “They can learn that not every conversation has to be fight-or-flight. It’s a marathon, not a sprint, for sure, just as with any chronic illness. Help clients pace themselves.”

> Find the right words: An individual with food allergies (or the parents of a child with food allergies) will need to explain the allergy to everyone from school staff to well-meaning relatives who are hosting a holiday dinner. Be aware that there can be cultural and generational differences in levels of understanding and flexibility surrounding food allergies, Hubbard advises.

“This can be hard for people who aren’t comfortable speaking up. If they’re not a natural advocate, it will now fall to them to educate [others] and advocate,” she says. “A counselor can help them manage the feelings around that, [including] frustration, burnout and exhaustion.”

> Guide children (and parents) as they grow up: Parents may find themselves growing anxious as their child with food allergies ages, develops more independence and spends more time away from home. Counselors can offer support as these families navigate the child’s developmental milestones. This might include encouraging the family to gradually give the child more freedom and responsibility to make safe choices independently.

For example, teenagers who are beginning to date may have to inform their love interests that they shouldn’t kiss for a while after the person has eaten something containing an allergen. “For every phase of life, there will be an additional need to explain and educate [about the allergy], and that can be exhausting,” Hubbard says.

> Be aware that “relapses” are possible: Clients who have made progress on accepting a food allergy and managing the emotions that come with it can “go back to ground zero” anytime they experience an allergic reaction or exposure scare, Hubbard says. Counselors shouldn’t be disappointed if these clients sometimes backslide on the progress they have previously made in therapy.

> Work with the allergist: Professional counselors shouldn’t hesitate to contact a client’s allergist (if the client grants permission). Counselor practitioners can learn a lot about the specifics of a client’s needs from the allergist, Hubbard says. For example, some food allergies are milder, whereas others can cause a reaction even from airborne exposure (for example, peanut dust). “Each client will have a specific set of data [regarding his or allergy],” Hubbard explains. “It’s important to stay connected with their allergist and check in to help you better understand.”

> Be cognizant that allergy-related bullying does happen: Being aware of allergy-related bullying is especially important for counselors who work in school settings or with children and adolescents in their practice, Hubbard notes. Up to one-third of children with food allergies have faced bullying, according to FARE.

This can include overt bullying, such as taunting or threatening a classmate with an allergen. But allergy-related bullying can also come in less obvious forms, such as when an adult (teacher, sports coach, etc.) points out the individual with an allergy and labels them as the “reason” the class or team can’t have certain foods. This type of scenario can make individuals feel bad about their allergies and the inconveniences they may present, Hubbard says.

 

****

 

The Food Allergy Counseling Professionals Networking Group

Started by Tamara Hubbard, this group is open to counselors who work with clients who are managing food allergies. Connect with them on Facebook: facebook.com/groups/FoodAllergyCounselingProfessionals/ to share resources and network with other professionals who specialize in this area.

 

****

 

Contact Tamara Hubbard and find resources at her website: foodallergycounselor.com

Hubbard also writes a blog on allergy-related issues, including a series titled “Four things counselors should know about food allergies.”

 

 

****

 

Related reading

Hubbard suggests the following resources for counselors or clients looking to learn more about food allergies and their connection to mental health:

 

 

****

 

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

 

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

 

****

 

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 ‘storm and stress’ of adolescence and young adulthood

By Laurie Meyers October 25, 2018

For much of human history, the idea of adolescence being a distinct life stage was nonexistent. True, in the Middle Ages, children were recognized not merely as “mini” adults but as distinct beings with different needs. However, the years from ages 13 to 19 were not considered part of childhood until the turn of the 19th century. Instead, the “teen years” were the time when one began to assume adult responsibilities such as making a living and starting a family.

During the late 1800s, changes in child labor laws and the push for universal education for those under the age of 16 began to influence society’s perspective on when adulthood began. G. Stanley Hall, the first president of the American Psychological Association (APA), is credited with the modern “discovery” of adolescence, defining it in a 1904 book as a new developmental stage — created by societal changes — in which children grow into adults. Hall described adolescence as a time of “storm and stress” and, unlike later researchers, ascribed this life stage as lasting from ages 14-24 (rather than today’s generally accepted range of 13-19).

Although adolescence is still considered to be synonymous with the teen years, Hall’s instinct to single out the early 20s as different from later “adult” years was prescient. In the past decade, neurological research has discovered that the brain does not fully mature until one’s mid-to-late 20s. This revelation has spurred many researchers, particularly in mental health fields, to call for a separate developmental stage that is generally referred to as “young” or “emerging” adulthood.

Adding more than a soupçon of complication to both the recognition of emerging adulthood and the established research on adolescence is the reality that being a teen or 20-something in the information age is, in many ways, significantly different — and arguably more difficult — than it was for previous generations.

Stressed and depressed

An abundance of research indicates that teens and young adults are experiencing increased levels of stress and depression. In recent years, APA’s annual “Stress in America” survey has gathered data only on adults. However, in the survey released in 2014, “Stress in America: Are Teens Adopting Adults’ Stress Habits?” young people ages 13-17 were also included.

Survey respondents reported that during the school year, they had a stress level of 5.8 on a 10-point scale. During the summer break, teens reported a slight decrease in stress levels — 4.6 on a 10-point scale. Furthermore, 31 percent of survey respondents said that their stress levels had increased over the past year. In response to their high levels of stress, 40 percent of respondents reported feeling irritable or angry, 36 percent reported feeling nervous or anxious, 36 percent reported feeling fatigued or tired, and 31 percent reported feeling overwhelmed.

Depression is another significant concern among adolescents. According to the National Institute of Mental Health, in 2016 (the most recent year for which statistics are available), an estimated 3.1 million adolescents ages 12-17 experienced at least one major depressive episode. That number represented 12.8 percent of the U.S. population in that age bracket.

Although most mental health surveys do not specifically target “young” or developing adults, data are available relating to college students. Among the more than 31,000 college students who completed the 2017 American College Health Association National College Health Assessment, 39.3 percent reported being so depressed that they found it hard to function at some point during the previous 12 months. Anxiety levels among respondents were even higher: 60.9 percent reported feeling overwhelming anxiety at some point during the prior year.

The high levels of anxiety and depression indicated in these studies are part of a national pattern of significantly increasing distress. A national poll published in May by the American Psychiatric Association noted a sharp increase in American anxiety levels over the past year. On a scale of 0-100, this year’s “national anxiety score” was a 51 — a five-point jump since 2017. A study published in the June 2018 issue of the journal Psychological Medicine found that rates of depression rose across all age brackets of Americans for those 12 and over from 2005 to 2015. Most significantly, among those ages 12-17, depression rates increased from 8.7 percent in 2005 to 12.7 percent in 2015.

Under pressure

Some researchers are eager to blame technology — particularly social media — for the increase of depression and anxiety among teenagers and young adults. The reality is more complex and involves myriad factors.

It is undeniable that some people do find their lives lacking when compared with what they see on social media. Carefully curated Facebook feeds can suggest to them that their friends are happier and more successful than they are. Celebrity photos on Instagram — most of which are professionally produced and heavily filtered — can encourage unrealistic expectations about body image and personal appearance. However, when one considers the role that social media plays in the quest for perfection, it may be something of a chicken-and-egg scenario.

A 2017 study on perfectionism that appeared in the journal Psychological Bulletin found that beginning in the 1980s, a culture of “competitive individualism” in the United States, Canada and the United Kingdom steadily increased the quest for personal perfection. So, is what we see on social media pushing us toward unattainable standards of perfection, or is it a reflection of the pressure we put on ourselves? At this point in time, we may be caught in a reinforcing loop. The study found that current generations not only feel intense societal pressure to be perfect but also expect perfection from themselves and others. The study’s authors also believe that this rise in perfectionism may be linked to an increase in myriad psychological problems.

Today’s teenagers and young adults are unquestionably subject to high expectations and demands. Licensed mental health counselor David Flack, who has worked with adolescents and young adults for 20 years, says he has seen a significant increase in anxiety related to academic performance among his clients.

“It is not uncommon for teens I meet with to have three, four or even more hours of homework most days,” he says. This reality creates significant pressure and is particularly stressful for students who are predisposed to anxiety. Flack, a member of the American Counseling Association, also believes that such heavy academic workloads are interfering with important social and developmental processes because many teenagers may be spending more time doing homework than socializing and engaging in extracurricular or other age-appropriate activities.

Licensed professional counselor (LPC) Sean Roberts, an ACA member who specializes in working with young adults, says he has witnessed a precipitous increase in anxiety among clients. He thinks this is strongly, though not solely, linked to teenagers and young adults feeling increased pressure to succeed.

Not coincidentally, the anxiety they experience makes it only more difficult for them to achieve. “Anxiety has a neurological effect,” explains ACA member Amy Gaesser, an assistant professor of counselor education at the State University of New York at Brockport whose research focuses on the social and emotional well-being of students in school. “The survival part of the brain activates and shuts off or interferes with the parts of the brain that help us think clearly.”

This can have a significant effect on academic performance, says Gaesser, a certified school counselor in New York who gives presentations and offers private consultations with parents. For example, some students can study extensively and be fully prepared for a test, but because of their anxiety, can have trouble accessing that information while taking the test. Anxiety can also interfere with the ability to take in and synthesize information, Gaesser says. Students become frustrated with their seeming inability to “get it,” which affects their feelings of self-efficacy and can even make them question their level of intelligence. Once a pattern of academic difficulty tied to anxiety is established, the problem can become self-perpetuating.

Disrupting the cycle is vital, says Gaesser, who recommends the emotional freedom technique (EFT) as an effective method of interrupting the stress response and downregulating the brain. In EFT, participants respond to stressful thoughts or situations by visualizing an alternative outcome while taking their hands and tapping acupuncture points on the body that have been linked to stress reduction. Students can go through the whole sequence of body points or just use the areas they find work best for them, she says.

Gaesser also recommends the “4-7-8” breathing method as a quick way to interrupt the stress response. This involves breathing in for four seconds, holding the breath for seven seconds and then breathing out for eight seconds. Students can practice this method themselves, but Gaesser thinks that teachers should also use it in their classrooms as a way to begin class.

Peter Allen, an LPC based in Oregon who specializes in counseling young adults and adolescents, used to work with teenagers in a wilderness therapy setting. Most of his clients were struggling with a variety of issues, including substance abuse, conduct problems (although not usually at the conduct disorder level) and mood disorders, principally depression and anxiety. In most cases, Allen says, the core elements of the wilderness setting were effective in helping these clients address their various presenting issues.

In part, he believes that’s because the pressures of school, family and social life were stripped away, leaving these teenage clients to focus on the basics, such as securing food and shelter. Surviving in the wilderness also required working together and building a community, which helped teach clients new communication skills. Participants also got daily exercise, ate healthy meals and were required to follow a regular sleep schedule, all of which had a calming and stabilizing effect. “Once diet, sleep and exercise have been regulated, about half of the problems disappear right away,” Allen says.

Many wilderness therapy clients also benefit from what Allen calls “expanding the size of their world. … If you are a 15-year-old kid and doing bad at school, arguing with your parents, your world is tiny.” The wilderness program not only provided literal wide-open spaces, but also introduced clients to people from different places and adults who didn’t have the same expectations as the teenagers’ parents or teachers did.

The wilderness can also serve as a mirror for clients, says Roberts, who has also worked in wilderness therapy, or, as he says it is becoming more commonly known, outdoor behavioral health care. For instance, when clients who struggle with executive function and organization encounter bad weather for which they are not prepared, the experience can be a vivid demonstration of the importance of working on those problem areas. Another example: Someone who is struggling with distress tolerance will need to get used to having to build a fire after hiking all day.

Information overload?

Although none of the counselors interviewed for this article view social media or technology as inherently negative, they agree that living in the information age is complicated. The current generation of teens and young adults is awash in an unprecedented flood of information, asserts Roberts, clinical director at Cascade Crest Transitions, a program that provides support to young adults struggling to launch their independence by attending college or obtaining a job. He maintains that this technological bombardment not only is difficult to assimilate but also can encourage the tendency to “get stuck” in one’s own head.

Allen adds that in the age of the internet, children and adolescents are exposed to a lot of information and knowledge at an earlier age than previous generations were. In certain cases, it is information that they may not have the maturity to handle. For example, most children and adolescents who grew up in the latter half of the 20th century had to somehow get their hands on a copy of Playboy or another adult magazine to satisfy their sexual curiosity. Today’s children and teens are exposed online to myriad genres of easy-to-access pornography, which not only present unrealistic ideals of sexuality but also can include disturbing practices such as bestiality and pedophilia. Children and young adolescents today are also more likely to be exposed to media coverage of frightening or horrific events before they have the ability to contextualize all that they are taking in, Allen says. He believes this early exposure is contributing to a kind of “nonspecific existential dread” that he says he commonly sees in his clients.

Roberts says that technology offers many positive benefits, but it also sometimes provides adolescents and young adults with a means to avoid their problems. He stresses the need for counselors to learn more about the draw of technology so that they can help clients evaluate whether they are using it in positive or negative ways. Roberts gives gaming as an example. For those who know little about it, gaming may seem like an excuse to “do nothing.” In reality, he says, it is a legitimate hobby that can provide enjoyment, stress release and even a sense of community while boosting problem-solving skills. However, like any other activity, when gaming gets in the way of schoolwork, chores or getting out of the house, it becomes a problem to be addressed, he says.

Another complicated aspect of online life is social media. For all the potential benefits, social media feeds have made it so that virtually no part of life is private anymore, Allen says. Many adolescents may not fully understand that by making everything public, the internet is, in essence, “forever” or grasp the potential ramifications of that reality, he says. In addition, he notes, social media feeds can encourage social contagion.

ACA member Amanda LaGuardia, a former private practitioner whose research focuses on self-harm, agrees. Much of the social media content targeted to young girls is focused on body image, says LaGuardia, a licensed professional counselor supervisor in Texas and a licensed professional clinical counselor supervisor in Ohio. Many of her former clients talked about the images they saw on Instagram, such as already-thin celebrities discussing “thigh gap” (as part of a supposedly “perfect” body, women and girls must have thighs that don’t touch each other) and other unrealistic physical standards. Such posts are usually popular, garnering a large number of likes and admiring comments, which gives girls the impression that this is what their bodies should look like, she says.

However, such standards are unrealistic for most females and are simply unachievable for girls with developing bodies, continues LaGuardia, an assistant professor at the University of Cincinnati. Regardless, these images are presented as the feminine ideal, presuming to highlight all of the elements that will make women attractive to men. At the same time, girls are often subject to sexual harassment at school and too often told by those in authority “that’s just how boys are” (boys will be boys) and that girls just need to find a way to deal with it, she says.

All of these messages about how girls should look and act and what they should accept come at a time when they are already struggling to figure out who they are. It is overwhelming, and self-injury is becoming a more common way to cope with the distress. Self-harm used to be most common in the eating disorder population, but according to LaGuardia, social media has introduced it to a wider audience. It isn’t necessarily that self-injury is presented as a positive behavior online. Most people who talk about it on social media are seeking support, she says. However, the widespread nature of the discussion has created social contagion.

The best thing counselors can do to help is listen and affirm, LaGuardia emphasizes. When adolescents talk about their experiences, some counselors focus on helping them feel better about themselves, but that is not what they need most, she asserts. Instead, adolescents need to express what they are going through and to process their confusion verbally. Counselors should respond, she suggests, by saying things such as, “That sounds really difficult” and “I’m here and I’m listening.”

“So many of the messages they [adolescents] are receiving are controlling,” LaGuardia explains. “They need to feel in control.”

As these clients become more comfortable, they will begin to talk about how they are coping with their turmoil. LaGuardia explains that these clients view self-injury as a means of surviving what they are currently experiencing, not a solution. “I ask clients, ‘Is this something you see working for you for the rest of your life?’ I’ve never had anyone say yes.”

Usually, LaGuardia notes, clients will say that they hope not to engage in self-harm forever, but at the current time, they don’t know what else to do. At that point, counselors can ask whether this coping method is something the client is ready to change. LaGuardia says the first step is finding out what the client needs help coping with and then exploring ways that will allow the client to cope without self-harm.

The most common underlying problem for clients who self-harm is conflict with a parent or sibling, LaGuardia says. In such cases, she works with the whole family on communication skills. She starts with the adolescent clients, teaching them how to express their needs without self-injury. She asks the adolescents to think about their most stressful conflicts and what they would like their parents to know. Then, through role-play, LaGuardia helps these clients practice asking for what they need.

Often, LaGuardia will also bring in the parents and have the adolescent express the source of conflict. As the parents and adolescent talk, things can get heated, so LaGuardia is there to help redirect the conversation. She also tries to educate parents about what adolescents need, which includes being treated as independent young adults and given space to grow, while at the same time knowing that their parents are always there to listen to them regardless of
the circumstances.

Adult transitions

Allen is the program director at College Excel, a residential, coaching-based college support program. The program’s clients are typically young adults who are coming out of high school and looking for extra support to succeed in college or those who previously attended college but dropped out because of a mental health issue or learning disability.

Many of the students have some level of anxiety and depression and often struggle with executive function deficits. College Excel provides the students with mental health support and coaching on life and study habits. Allen says he tries to run the program through the lens of good mental health practices. Calling on his background in wilderness therapy, he also encourages students to eat well, follow a consistent sleep schedule and get regular exercise. College Excel staff do not live on-site, but the program does provide students with housing, which helps them establish a sense of community and support — elements that are common among those who successfully adjust to college life, Allen points out.

Allen says that many of the program’s clients struggle with attention-deficit disorder and organization. College Excel staff teach students basic organizational skills such as using their attention strategically. For example, with students who struggle with memory and retaining information, Google Calendar can be a particularly useful tool. It can tell students where they need to be at any given moment, freeing up their attention and memory for other tasks.

Allen also talks with students about the importance of a clean workspace and provides them with practical tips on organization. For example, he says, students who constantly misplace things can save time and frustration by designating a space for pens, papers and other basics so that they will always know where to find them.

Students also work on developing good study habits. For example, rather than growing frustrated with their struggles to focus on what they’re reading for long periods of time, clients learn to study in 15- to 20-minute chunks, with five-minute breaks in between.

Roberts’ program is geared toward young adults who are coming from inpatient treatment and are ready to enter college or find a job. In addition to receiving ongoing mental health treatment, these clients take classes that focus on interpersonal skills, stress regulation, goal setting, time management and money management. They are also encouraged to exercise, and all students are matched with a case manager who helps them focus on sleep hygiene, peer interaction, health and nutrition, and, in some cases, dating.

Clients are required to attend one individual and one group counseling session per week. Counselors are also on-site five days a week, which allows them to give feedback outside of sessions. For example, a counselor might say to a student, “You say that you want to socialize, but you’re constantly retreating to your room or on the phone.” This opens up a discussion about why the student isn’t following through on counseling goals and allows the counselor and client to work on solutions together, Roberts says.

The students are usually enrolled in college or working when they start Roberts’ program. The coaching and classes take place around the students’ schedules, and staff members are available to help clients through whatever challenges they are facing in school or at work. Clients typically remain in the program about nine to 12 months. During the last six months, they move out of program housing and into their own apartments or college dorms.

Allen closes by noting that today’s adolescents and young adults — the oft-discussed millennials — are very much aware that older generations generally view them in a negative light. He believes this widespread maligning carries a psychic weight for this generation and can contribute to limiting their self-efficacy and sense of options.

Because this negative image of adolescents and young adults is so prevalent, Allen believes that even counselors may fall prey to it. “You can’t hold them in contempt and do good work,” he emphasizes. “The best thing we could be doing for them is stoking the fire of creativity.”

 

****

 

Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

Books and DVDs (counseling.org/publications/bookstore)

  • Youth at Risk, sixth edition, edited by David Capuzzi and Douglas R. Gross
  • A Contemporary Approach to Substance Use Disorders, second edition, by Ford Brooks and Bill McHenry
  • Active Interventions for Kids and Teens, by Jeffrey S. Ashby, Terry Kottman and Don DeGraaf
  • Suicide Assessment and Prevention, DVD, presented by John S. Westefeld

ACA Mental Health Resources (counseling.org/knowledge-center/mental-health-resources)

  • Suicide Prevention
  • Substance Use Disorders and Addiction
  • LGBTQ Resources

Webinars (aca.digitellinc.com/aca/pages/events)

  • “Depression/Bipolar” with Carmen S. Gill (CPA22120)
  • “Trauma/OCD/Anxiety” with Victoria E. Kress (CPA22118)
  • “Substance Abuse/Disruptive Impulse Control/Conduct Disorder” with Shannon Karl (CPA22116)
  • “Counseling Students Who Have Experienced Trauma: Practical Recommendations at the Elementary, Secondary and College Levels” with Richard Joseph Behun, Julie A. Cerrito and Eric W. Owens (CPA24339)

 

****

 

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

Letters to the editor: ct@counseling.org

 

****

 

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.

Helping clients with post-date anxiety

By Kathleen Smith October 15, 2018

As a counselor, I have a front-row seat for watching anxiety develop in new relationships. It is truly fascinating to observe how quickly two people can become emotionally stuck together. A therapy client will leave for a week and return reporting that he or she has started dating someone new. This former stranger now has the power to make my client very happy or very anxious. Thanks to their phone, my client might spend all day analyzing a text they received — or worrying about the lack of one.

Not a week goes by without me having multiple conversations with people about texting in relationships. For instance, a person is seeing someone who doesn’t quite contact them as frequently as they would like, so their brain sounds the rejection alarm. When the other person finally does text them, their anxiety level goes down. But within a day or two, they need more reassurance. They’ve surrendered their capacity to calm down to someone who was a stranger to them a week ago. And the only way they know how to get that capacity back is to end the relationship.

I don’t think that texting causes emotional dependence, but it can certainly accelerate it and reinforce it. People used to have to wait much longer to hear from a prospective romantic partner. Now people want to hit the eject button if there’s been radio silence for 24 hours. There is an expectation that someone who is interested in us must also be available to us at all times. We are in such a hurry to lock things down as a way of managing our own anxiety and insecurity.

I’m in no position to throw a stone here. After my husband and I went on our first date, he waited five days to ask me out again. Five. Days. For millennials, five days is the equivalent of somebody going off to war and coming back home. Now, of course, I know that he was a mature human being who was simply living his life at that time. But if you retrieved my phone records from that week, I bet you would see a blizzard of worried texts to friends.

When our counseling clients become more anxious in a new relationship, they don’t suddenly become more insightful. They usually just double down on whatever they’ve already been doing. That usually means anxiously focusing even more on this new person. They might stalk them on social media, or stare at their phone trying to decipher old texts. They’ll talk to all their friends about whether they should dump this person for taking so long to reply. They’ll come to a counseling session and ask me to guess what this person — whom I have never met coincidentally — is thinking.

When we feel the potential to be hurt, it makes sense that we focus more on the threat and how to avoid it. This works great if a lion is chasing us. It’s not so great for being in a relationship.

People see a lot of lions when they date, simply because dating is such an anxious endeavor. They interpret a lack of constant contact in a new partner as a sign of flakiness, disinterest or duplicity. People don’t stop to consider whether less contact might be a potential sign of maturity. This is why people tend to end up with other people who are at the same level of emotional maturity as themselves. People who have a higher degree of maturity in their family relationships are likely to seek out a partner who wants the same amount of contact.

I would never say to a someone, “Have you considered that this person is not texting you as much because they’re more mature?” Because that would be a guess based on zero facts. What I do challenge people to do, however, is to see their part in the relationship. Often, if people can stay focused on being the person they want to be rather than on trying to control this new love interest of theirs, then their anxiety will go down. And most of the time, people do not want to be the kind of person who is glued to their phone 24/7.

So, the goal isn’t for clients to change their new crush or to teach the person how to text that Goldilocks (just right) amount. The goal is to lower clients’ anxiety enough to where they can actually think objectively and decide whether a relationship is right. That decision is impossible to make when anxiety is very high, because then we interpret even the smallest behavior as a threat. People will blow up a relationship quickly in order to lower their anxiety.

Anxiety isn’t just present in romantic relationships, of course. We all want people to like us, reassure us and agree with us, but we ultimately can’t control them. People in our lives are not always going to respond as quickly as we would like. They’re not always going to RSVP to the party or share our level of enthusiasm for a television show. If clients can see how the anxiety they feel is a possible sign of emotional interdependence, they might be less likely to act immaturely or irrationally in their relationships. The rejections or silences won’t feel so threatening, and they won’t have to cancel that party out of spite or send a passive-aggressive message.

The simple truth is that we enjoy relationships more when we aren’t as anxiously focused on them. By being more of an individual, we can actually get closer to the people we love. Who doesn’t want that?

 

****

Kathleen Smith is a licensed professional counselor and writer in Washington, D.C. Read more of her writing at kathleensmith.net.

 

*****

 

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.

 

Infusing hope amid despair

By Laurie Meyers September 24, 2018

In 2015, two Princeton University economists, Anne Case and Angus Deaton, published a study in the Proceedings of the National Academy of Sciences of the United States of America that made a shocking claim: After decreasing for decades, the mortality rate for white non-Latinx middle-aged Americans was actually increasing. They ascribed this reversal of fortune in part to what they dubbed “deaths of despair” caused by an increase in alcohol abuse, opioid use and suicide. Their findings grabbed headlines and fueled furious debate in the public health and other research communities, particularly when they published a follow-up report in 2017 in the Brookings Papers on Economic Activity. Some researchers questioned the authors’ interpretation of mortality data. Other experts argued that the factors contributing to the rise in suicide rates and in opioid and alcohol abuse were too complex to be attributed to “despair.”

However, despite their narrow focus on a particular demographic slice, Case and Deaton were perhaps tapping into a greater sense of instability among the American populace. Since 2007, the American Psychological Association (APA) has conducted an annual nationwide survey — Stress in America — gauging both the overall level and leading sources of stress in the United States. The 2017 report revealed that two-thirds of the 3,440 adult Americans surveyed that August were significantly stressed about the future of the country. More than half of those surveyed — a group that spanned generations — said they considered the current time to be the lowest point in U.S. history that they could remember. Nearly 6 in 10 adults reported that the current climate of social divisiveness was a serious source of personal stress. Other significant sources of worry included money, work, health care, the economy, trust (or lack thereof) in government, hate crimes, conflicts with other countries, terrorist attacks, unemployment/low wages and climate change/environmental issues.

Although Americans may not be drowning in despair, research such as APA’s report indicates that many people are feeling more insecure than ever. That sense of walking a tightrope without a safety net can cause significant psychological distress, which can in turn lead to health problems and mental illness. Many experts say the burden of general societal unease is often magnified for disenfranchised groups such as communities of color or those of low socioeconomic status. And trauma — whether caused by being a member of a disenfranchised group or by a history of abuse or violence — takes an even more significant toll on health and well-being. Any or all of these issues may be related to the rise in opioid addiction and suicide across the U.S.

A poverty of health and well-being

To some degree, most people in the so-called 98 percent — those not in the top 1-2 percent of individuals possessing the majority of the nation’s wealth — worry about money: affording a mortgage, sending the kids to college, saving for retirement. The Great Recession may be over, but recent research from the Federal Reserve Bank of San Francisco (FRBSF) indicates that the economy hasn’t fully recovered. In its Aug. 13 economic letter, the FRBSF states, “A decade after the last financial crisis and recession, the U.S. economy remains significantly smaller than it should be based on its pre-crisis growth trend.”

The letter goes on to speculate that this is due to substantial losses in the economy’s productive capacity post-crisis. These losses were so significant, FRBSF researchers assert, that they could result in a lifetime income loss of $70,000 for each American.

This is staggering news for most Americans, but for those who live in poverty — 40.6 million Americans according to a 2016 U.S. Census Bureau study — such an amount is catastrophic. The poverty threshold is broadly defined as any single individual younger than 65 earning less than $12,316 annually and any single individual 65 or older living on less than $11,354 annually. The poverty threshold for two people under the age of 65 living together is $15,934, and the threshold for two people over the age of 65 living together is $14,326. For a family of three — one child and two adults — the poverty threshold is $19,055. For a family of three with one adult and two children, the threshold is $19,073.

For people who have never been impoverished, it can be difficult to comprehend all the ways in which poverty can affect health and well-being. Forget vacations, higher education and saving for retirement. People living in poverty are often unable to access basic needs such as safe shelter, food and, in some cases, even running water, says Chelsey Zoldan, a licensed professional counselor (LPC) practicing in Youngstown, Ohio. She has also counseled clients in the rural, impoverished Appalachian region of Ohio.

“I’ve worked with many clients over the years who have had their utilities turned off and lived in homes without water, heat or electricity,” says Zoldan, an American Counseling Association member. Missing that foundation at the bottom of Abraham Maslow’s hierarchy of needs, these clients struggle to stabilize their mental health symptoms, she explains.

People living in poverty often have to reside in low socioeconomic status areas with higher levels of violence and crime. Zoldan says many of her clients have lived in supportive housing and regularly heard gunshots in their neighborhoods at night. Although some clients seemed to get used to it, others — particularly those with trauma histories — had trouble feeling safe in their own homes.

Those who live in poverty also often lack access to quality health care. “Not only are individuals limited in terms of health care coverage, but they may also struggle to obtain transportation to get to health-related appointments,” Zoldan says. “In my area, there was such a high demand for medical transportation to appointments that they stopped providing door-to-door transportation and only provided bus passes.”

Instead of a 15-minute ride to appointments, Zoldan’s clients now had to navigate public transportation, which could take up to two hours each way with a change of buses. Riding the bus also poses another significant challenge — having to walk numerous blocks to the stop, which during winter in northeast Ohio means navigating “tons of snow” and double-digit subzero windchills, Zoldan says. Even in more clement weather, many of Zoldan’s clients were unable to devote two to four hours a day to traveling to health-related appointments, so they stopped receiving services.

Self-care can also prove challenging for those living in poverty, and it doesn’t include vacations or nights out. Zoldan works with individual clients to identify free activities that they enjoy and can engage in at least weekly, such as taking a bath, attending a Bible study, going for a walk in the park, meditating, and reading books or magazines at the library. Unfortunately, some of these activities may not be available to all clients, either because they live in rural areas with few resources or because they are unable to arrange child care, Zoldan points out.

Zoldan advises counselors working with this client population to get outside the walls of their offices. It is critical that counselors make community connections, she says, so that they can help clients access resources such as shelters, housing authorities, food banks, clothing providers, programs that offer financial assistance for utilities, medical transportation and vocational services.

“In connecting our clients with these resources, we can work to build a safety net for our clients and create some more stability in their lives so that they can thrive,” she says.

The legacy of racism

Racism happens on both a micro and macro level, says Cirecie West-Olatunji, a past president of ACA. Microaggressions are more nuanced and under the radar and involve everyday interactions with individuals who exert privilege. It might be the shop clerk who ignores an African American person in favor of a white shopper or a student of color who is consistently not called on, despite raising her hand. Macroaggressions are overt and meant to intimidate members of a group, such as neo-Nazis marching in the nation’s capital and people openly using racial slurs. Together, the macro- and microaggressions create pervasive, chronic stress that is handed down through intergenerational trauma, explains West-Olatunji, an associate professor at Xavier University of Louisiana and director of the Center for Traumatic Stress Research.

Over the past 20 years, researchers have been studying a phenomenon they first witnessed in some of the grandchildren of Holocaust survivors. Despite not having experienced the Holocaust themselves, and instead having grown up in a middle-class environment in the U.S., these individuals displayed survivor-like trauma symptoms. The findings were startling but have proved not to be unique. After 9/11, researchers studied children who had not been born at the time that their parents served as first responders at one of the attack sites. Like the grandchildren of the Holocaust survivors, these children of 9/11 trauma survivors displayed corresponding symptoms despite not experiencing the trauma themselves, West-Olatunji says.

Chronic, pervasive stress and trauma can be seen in changes at the DNA level, she says. Some researchers believe that these DNA changes play a part in handing down the trauma from generation to generation.

For African Americans, the trauma is also handed down on a systemic level, West-Olatunji says. “It is evident in social structures, education, lack of power and aggressive acts that threaten the psyche of individuals who are culturally marginalized,” she says. Slavery still casts a long shadow, its legacy evident in the school-to-prison pipeline, the number of African American children who are in low-resource schools, their overrepresentation in special education and the disproportionate diagnosis of behavioral disorders. “Children are being tossed out of the American dream by a lack of resources,” she says.

The effects of openly expressed racism are also manifesting in society, West-Olatunji says. “We’re anxious and irritable and feeling less hopeful about the world,” she says. These “symptoms” match those displayed by culturally marginalized groups.

Courtland Lee, also a past president of ACA, believes the effects of racism extend beyond the targeted group. In fact, he contends that racism can be considered a mental illness.

Lee began thinking of the concept of racism as mental illness after reading Stamped From the Beginning: The Definitive History of Racist Ideas in America, a book by Ibram X. Kendi that examines the intellectual roots of racism. Although many people may consider racism the purview of poor, white, rural Southerners, it has historically been handed down from the best and brightest minds in science, medicine, philosophy, religion and psychology, Lee explains. Racism is woven into our intellectual and social fiber and is used to manipulate people through fear of the other, he continues.

Lee says that targets of racist behavior are ground down by the constant micro- and macroaggressions, leading to “cultural dysthymia,” or collective low-grade depression. This collective depression is manifestly not conducive to mental health, and he argues that its effects aren’t felt solely by those who are targets of racism.

Lee believes that the fear and hatred of those who perpetrate racist acts is also mentally traumatizing — not just to those who are targeted but to the perpetrators themselves — and that the trauma must be addressed to treat the mental illness of racism. Counselors can do this on a systemic level through advocacy and on an individual level by helping people who are racist see that the agitation, irritability, hostility and hypervigilance they experience is caused by their beliefs. The challenge is getting perpetrators of racism to see that the defensiveness and fear inherent in racist thought can also bring those fears to life, Lee says.

For instance, one commonly cited reason to block immigration from Mexico is that these immigrants are stealing American jobs and damaging the economy. However, a lack of visas and fear of anti-immigrant violence have kept Mexican seasonal workers away from sectors such as the Maryland crab industry. In their absence, merchants who sell crab meat to restaurants and stores cannot recruit enough employees to clean and process their haul, even at high wages. That means the crabs cannot be sold, which is a major economic blow to the industry.

As a country, the United States needs to discuss racial issues, Lee says. Counselors, who are trained to encourage conversation, can and should facilitate these dialogues in their communities, through churches or community centers, he suggests. “We really do live in a sick society,” Lee says. “We can help people get well, but the only way to get well is to cure the society.”

As individuals, counselors can also play an important role in validating the experiences of people of color and speaking out when they witness micro- or macroaggressions, West-Olatunji says. She also urges counselors to explore non-Eurocentric methods, such as using the tradition of storytelling in the Latinx community or testifying in the African American community. Non-Western traditions can be applied effectively across cultures, making them a useful addition to any counselor’s toolbox, West-Olatunji says. 

Touched by trauma

“Life is a traumatizing experience,” says Cynthia Miller, an LPC in Charlottesville, Virginia, whose practice specializes in trauma. “It’s full of challenges, unexpected and uncontrollable events, and losses. I don’t think any of us gets through it unscathed.”

Miller, an ACA member, says trauma is on a spectrum that begins with ordinary stress and gradually progresses to completely overwhelm a person’s ability to cope. Eventually, it can even put them at risk of death.

A seminal study that the Centers for Disease Control and Prevention and Kaiser Permanente began in 1995 established a link between adult health problems and adverse childhood experiences such as emotional and physical neglect, sexual and physical abuse, exposure to violence in the household, and household members who had substance abuse problems or had been in prison.

These experiences fall on the more extreme end of the spectrum — often referred to as “big T” traumas. However, Miller cautions against discounting the “little t’s” as sources of distress. Where a trauma falls on the spectrum is individual and variable. “Some people might experience the loss of a job as stressful but wouldn’t be completely overwhelmed by it,” she explains. “Others might experience it as very overwhelming and become immobilized. So one person’s stressful event is another person’s traumatic event, and one person’s traumatic event is another person’s ordinary stressful event.”

Miller notes that mental health professionals recognize events such as the loss of a job, economic insecurity, divorce and family problems as sources of stress but often don’t accord them the same level of treatment as “real” mental illness. “It’s really a false distinction,” she says.

Someone who has lost a job or is going through a divorce is experiencing significant stress and is likely flooded with cortisol in the same way that a person who has experienced violence is, Miller asserts. “It’s really the chronic stress from either a ‘little t’ trauma or a ‘big T’ trauma that eats away at us and sets us up for depression, anxiety, anger problems, health problems and substance use,” she explains.

“There are a lot of things going on in society that could be experienced as traumatic,” Miller continues. “Globalization and automation are rapidly changing communities and workplaces, eliminating some industries and leaving workers scrambling for jobs that pay less and offer less job security. Economic inequality is growing, and housing costs keep rising. People feel increasingly insecure and like their futures are being threatened. That’s leading some people to feel helpless or hopeless. Others are angry and lashing out.”

Trauma-informed counseling is critical to recovery from both “big” and “little” traumas, Miller says, as well as for building ongoing resilience.

“I think that the biggest thing that trauma-informed counselors bring to the treatment process that less-informed counselors may not is an alternative explanation for behaviors that are often seen as purely manipulative, obstinate, oppositional, attention seeking or antisocial,” Miller says. “Trauma-informed counselors may be more likely to view a client’s reactions and behaviors as attempts to cope or protect themselves rather than chalking them up to resistance, treatment noncompliance or poor motivation. They also bring an awareness of the importance of creating a sense of safety and control for a client, and they work to create environments in which clients have as much autonomy and input into their treatment as possible.”

Miller also decries the traditional “split” between substance abuse and mental health treatment. Although she doesn’t believe that all substance abuse is caused by mental illness or trauma, she says these are often underlying factors that go untreated, which puts clients at risk of relapse.

Regardless of the cause, substance abuse is an illness that needs to be treated, she asserts. “For far too long, substance abuse has been treated as a problem of weak moral character rather than an effort to soothe emotional pain that someone doesn’t feel able to cope with,” she observes.

Miller also points to the contrasting public reactions to the crack and opioid epidemics. Whereas the crack crisis of the 1980s and early 1990s was considered a criminal problem, the current opioid epidemic is recognized as a public health problem, she notes. Miller ascribes this difference not only to the traditional judgment of substance abuse as a moral failing but also to the reality that crack was seen largely as affecting African Americans, while opioids are generally viewed as affecting white Americans. (Some researchers and commentators have also begun noting that the growing number of opioid-related overdoses and deaths among African Americans has largely been left out of the national narrative.)

Seeking solace

Just as crack enveloped areas that were economically devastated — at the time, predominantly African American urban neighborhoods — opioids are most common in rural areas that can no longer depend on the industries that once sustained them. West Virginia is one of the epicenters of the opioid crisis, and Carol Smith, an ACA member and past president of the West Virginia Counseling Association, believes that isolation and the lack of opportunity in much of the state are helping to fuel opioid abuse.

A frequently spun narrative of the crisis is that of unsuspecting people who get addicted after being prescribed opioids for pain after injury or surgery, but those cases make up a small percentage of those who are addicted to opioids, according to Smith. Indeed, people have been using opioids for pain relief for decades without becoming addicted on a large scale, notes Smith, a counseling professor and coordinator of the violence, loss and trauma certificate of studies at Marshall University. The people who do get addicted after being prescribed opioids usually already have substance abuse problems, she says.

However they first encounter opioids, the people most at risk for addiction are those who lack good coping skills and social support, Smith says. They typically also have a certain degree of existential despair, which is only reinforced by the long-term abuse of opioids.

Smith explains that West Virginia is particularly vulnerable to this sense of despair because its topography of mountains and waterways makes building roads and installing cables prohibitively expensive. This isolates the state not just physically but virtually because of the lack of high-speed internet access, she says. This lack of connectivity discourages new economic development, further reinforcing the cycle of poverty. As a result, many of the state’s inhabitants don’t feel that they have a lot to lose or much to strive for, Smith says, leaving them vulnerable to anything that might make the day go by faster or easier.

With its emphasis on treating the whole person, counseling is integral to the effort to stem the tide of addiction, Smith says. Counselors can help clients fight despair by guiding them to regain a sense of purpose through goal setting and identifying reasons for living. In addition, counselors can aid clients in dispelling their sense of isolation by teaching them relationship skills and helping them build support networks. Smith also stresses the importance of combining counseling with medication-assisted treatment, which addresses the physiological aspects of addiction.

Dying of despair?

According to the Centers for Disease Control and Prevention (CDC), 45,000 Americans 10 years and older died by suicide in 2016, the most recent year for which statistics are available. In the June CDC Vital Signs report, the agency said that from 1999-2016, the suicide rate rose by more than 30 percent in 25 states. While acknowledging that those suicide statistics are the most accurate figures available, the American Foundation for Suicide Prevention has stated that it believes actual rates are much higher.

Case and Deaton’s study connected the rise in the suicide rate in part to despair caused by a dearth of employment and lack of opportunity, but some experts say that causation is far from clear.

“It is hard to pinpoint a specific cause,” says ACA member Darcy Granello, a professor and director of the Ohio State University suicide prevention program. “Frankly, the numbers are increasing at such an alarming rate and across so many different demographic groups that we have to be careful not to paint broad brushstrokes and assume that specific factors apply to all of these different groups.”

Granello, whose research focuses on suicide prevention, does believe that Americans are feeling more isolated and disconnected, however. “That pervasive sense of loneliness is especially dangerous for those who already struggle with depression,” she says. “We know that social connectedness, feeling supported and having a sense of belonging all are protective factors that help minimize the risk for suicide. When those are taken away, suicide risk increases.”

Granello says myriad factors may be contributing to the rise in suicide, but recent research has caused experts to question their understanding of suicide. For example, historically, 90 percent of those who kill themselves have some kind of mental illness — often undiagnosed or untreated. However, more and more people who die by suicide do not have a diagnosable mental illness at the time of their death, Granello says.

“This is challenging to everyone in the field, and it causes us to rethink much of what we know,” she says. “It means that suicide is more and more the result of people who simply do not have the resources to cope with life’s problems, whether this inability to cope is because they are living with a mental illness or simply because they are overwhelmed by life and have never developed healthy coping strategies.”

Granello urges counselors to focus on helping clients develop those strategies. Those at risk for suicide are often ill-equipped to face life’s challenges, make long-term plans and envision a future, she says. For many people, the key to survival is getting through the crisis period — that window when they are most tempted to end their lives, she continues.

Counselors can teach clients to move out of their isolation, reach out to others and develop healthy coping strategies, Granello says. But to do that, counselors need to be adequately trained in suicide prevention, assessment and intervention — something that Granello doesn’t think is happening often enough. She stresses the need to push for comprehensive, empirically supported suicide prevention training in counselor education programs and through continuing education.

“We have to do this,” Granello says. “We are, quite literally, fighting for our lives.”

 

****

 

Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

Books and DVDs (counseling.org/publications/bookstore)

  • A Contemporary Approach to Substance Use Disorders, second edition, by Ford Brooks and Bill McHenry
  • Counseling for Social Justice, third edition, edited by Courtland C. Lee
  • Multicultural Issues in Counseling: New Approaches to Diversity, fifth edition, edited by Courtland C. Lee
  • Suicide Assessment and Prevention, DVD, presented by John S. Westefeld

ACA Mental Health Resources (counseling.org/knowledge-center/mental-health-resources)

  • Trauma and Disaster
  • Suicide Prevention
  • Substance Use Disorders and Addiction

Podcasts (aca.digitellinc.com/aca/store/5#cat14)

  • “Counseling African-American Males: Post Ferguson” presented by Rufus Tony Spann (ACA285)

Webinars (aca.digitellinc.com/aca/pages/events)

  • “Traumatic Stress and Marginalized Groups” with Cirecie A. West-Olatunji (CPA24341)
  • “Dissociation and Trauma Spectrum” with Mike Dubi (CPA24333)
  • “ABCs of Trauma” with A. Stephen Lenz (CPA24329)

Competencies (counseling.org/knowledge-center/competencies)

  • Multicultural and Social Justice Counseling Competencies

 

****

 

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

Letters to the editor: ct@counseling.org

 

****

 

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.