Tag Archives: stress & anxiety

Coping with the (ongoing) stress of COVID-19

By Lindsey Phillips May 21, 2020

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

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

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

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

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

Coping with uncertainty

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

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

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

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

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

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

Coping with loss

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

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

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

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

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

Building resilience

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

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

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

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

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

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

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

Adjusting coping and self-care strategies

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

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

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

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

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

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

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

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

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

Coping as a community

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

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

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

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

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

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

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

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

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

Coping as a counselor

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

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

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

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

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

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

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

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

Adjusting to a new normal

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

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

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

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

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

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

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

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

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

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

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

But for now, just take a deep breath.

 

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

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

How do counselors support clients during the coronavirus pandemic?

By Yoon Suh Moh and Katharine Sperandio April 9, 2020

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

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

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

What does this outbreak mean to our clients?

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

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

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

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

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

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

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

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

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

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

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

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

Recommendations for counselors

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

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

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

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

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

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

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

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

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

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

Conclusion

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

 

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

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

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

A note of encouragement for counseling students during COVID-19

By Dana M. Cea April 7, 2020

The current situation with COVID-19 and the effect it is having on counseling students’ lives can cause stress, anxiety and uncertainty. In my role as a doctoral student supervisor, I am hearing these stories from supervisees and their classmates. Thankfully, my department, the Department of Addictions and Rehabilitation Studies at East Carolina University, has jumped to action to support all of its students, especially the practicum and internship students. However, the faculty are limited in what they can do based on decisions made by the Council for Accreditation of Counseling and Related Educational Programs (CACREP).

Keep in mind that there are more than 800 CACREP-accredited programs, which could mean over 10,000 counseling students. All of you are in the same boat and are doing your best to stay afloat. Without flexibility in standards, we could find ourselves with an even larger shortage of mental health professionals over the next couple of years.

As graduate counseling students, you have no control over CACREP, of course. What do you have control over? The following recommendations may not be new to you, yet they are helpful. In fact, you may already be sharing some of these with clients.

Keep your schedule. We all know how helpful schedules and routines are in maintaining our mental health. Although you may not be going to classes or work sites right now, keeping the schedule you had previously or adjusting to a new reasonable schedule is wise. Include a morning routine and a routine for bedtime. If you find that you suddenly have a little extra time each day, explore options for how you can use that time, such as sleeping in, exercising, meditating or doing crafts.

Check in with classmates and colleagues. My Ph.D. student cohort has a group chat, and the Navigate Counseling Clinic where I provide counseling services does too. One day during our “spring break 2.0,” I realized how much I missed seeing my cohort and needed a check-in. When I scheduled a video conference, the other members of my cohort found this funny because I am not known to be the most touchy-feely person. But seeing their faces was so helpful for me. We also host weekly video conferences with the Navigate clinicians, internship students and practicum students. Group chats are great, especially for pet photos and memes, yet video conferences take that connection to the next level.

Check in with your progress. Now is a great time to figure out what you need before you take that next step, whether it be for practicum, internship or becoming licensed. Seek help from faculty, supervisors, webinars and other learning opportunities. I created a “counselor dunking booth” in which supervisees are able to play a short clip of a TV show, movie or counseling tape or create a case study and challenge me concerning how I would address the situation or client. Even if you are unable to go to your site or do telehealth, there are many opportunities to sharpen your skills, knowledge and abilities.

Check in with yourself. How are you holding up under the current stress? Is it affecting your ability to work with clients or complete necessary coursework? If you are having a hard time answering these questions, ask those who know you best. Now may be a good time to find a counselor for yourself if you have not done so already.

Many counselors are indicating their ability to provide telehealth on their personal websites or on Psychology Today’s Find a Therapist directory. The Pandemic Therapists website is compiling a nationwide list of counselors providing support during the current situation. Keep checking back because new resources are being added. If money is a concern, some counselors may offer sessions for free or for a small fee to counseling students. Also check out Open Path Collective and Give An Hour. Do not forget to connect with your state’s National Alliance on Mental Illness organizations and affiliates. The national organization has a helpline that can assist you in finding counselors.

The bottom line is that as a counseling student today, you will be even better prepared than some licensed clinicians once you enter the counseling field. You will be able to show great empathy to clients when they seek services to manage the lasting effects of the COVID-19 pandemic. You likely will have gone through a crash course in telehealth or, at the very least, learned how to quickly shift your learning online. You will have a deeper understanding and appreciation for the human connections that we offer to clients as counselors.

You will emerge stronger for having gone through this experience.

 

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Dana M. Cea, pronouns she/her or they/them, is a volunteer for the National Alliance on Mental Illness and the American Foundation for Suicide Prevention, a mental health professional, a survivor of suicide loss, and a doctoral student at East Carolina University. She focuses her research on mental health and suicide, the LGBTQ+ community, youth, and autism spectrum disorder. Dana lives with mental health disorders, her spouse, and their three dogs. Contact her at danamcea.com.

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

@TechCounselor: Managing the culture of breaking news

By Adria Dunbar March 23, 2020

In the very beginning, social media sites, such as Facebook and Instagram, were more about connecting with people you know in real life or updating your profile to reflect the ways in which you hoped others would see you. The addition of the Facebook newsfeed (and its Instagram equivalent), however, changed everything.

The definition of news is “newly received or noteworthy information, especially about recent or important events.” I don’t know about you, but in my experience it has become harder to filter that which is noteworthy and important from that which is not. My newsfeeds are filled with everything from sponsored advertisements to photos of random acquaintances’ travel adventures. Mixed in, there are local events that I’m interested in attending, close friends’ and family’s announcements of major life events, and comments addressed to me. The problem is a newsfeed treats each of these pieces of information with the same attention. It’s all breaking news, and we receive it as such, and this has an impact.

Breaking news! Someone I haven’t spoken to in 20 years made pancakes for breakfast.

Breaking news! A close friend is in need of help finding a counselor for her daughter.

Breaking news! A piece of legislation that impacts counselors and other mental health professionals has been introduced and needs counselor support.

How do we, as counselors, regain control of our newsfeeds? How do we help clients do the same? The first step is reflecting on the impact of this breaking news culture on your personal and professional life. Consider the following:

  • How much time do you spend filtering through your newsfeed? Is this an amount you feel comfortable with?
  • After reading your newsfeed, how do you feel? Happy? Productive? Or distracted and stressed?
  • In what ways do you find yourself mindlessly or mindfully interacting with your newsfeeds?
  • How do you access your newsfeed? Does the context affect your behavior? For example, I do not have the Facebook mobile app on my iPhone. I only check my newsfeed from my laptop to ensure that I am not filling random 5-15 minute downtime intervals with mindless scrolling.
  • Think about the timing of when you ingest breaking news. For example, checking a newsfeed first thing in the morning can set the tone for your day or decide how you direct your morning energy and attention.

The next step is to make changes that help you manage breaking news, such as:

  • Consider removing apps with newsfeeds from your mobile device.
  • Hide your newsfeed completely from the desktop version of social media sites.
  • Eliminate—or hide– people, pages or accounts that are not having a positive impact (both Twitter and Facebook allow you to “mute” rather than unfriend or unfollow).
  • Narrow your follow or friend list to 25-50 people and pages that are most meaningful to you.
  • Turn off notifications to avoid constant distraction

Technology, while helpful in many ways, has created a daily existence that calls for our attention to be pulled in many different directions at once. This can leave us, and our clients, feeling distracted, scattered, and stressed. By intentionally filtering our newsfeeds to better match our values, we can stop the relentless breaking news from breaking through so only that which is most important gains our attention.

Now, more than ever, it is imperative that we take care of ourselves when filtering information through social media and traditional media outlets. Let’s all please take care of ourselves so that we can continue to do the work of taking care of others. It’s OK to set boundaries, create buffers, and take breaks.

 

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Adria S. Dunbar is an assistant professor in the Department of Educational Leadership, Policy and Human Development at North Carolina State University in Raleigh. She has more than 15 years of experience with both efficient and inefficient technology in school settings, private practice and counselor education. Contact her at adria.dunbar@ncsu.edu.

@TechCounselor’s Instagram is @techcounselor.

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

Deconstructing anxiety

By Todd Pressman January 6, 2020

I have always found it tremendously frustrating that our rational minds can’t convince us that most of our fears and anxieties are nothing to be afraid of. Many of my clients express the same frustration. As philosopher Michel de Montaigne said, “My life has been full of terrible misfortunes, most of which never happened.” Sadly, this is true for many of us, and no amount of positive thinking, affirmation or even cognitive transformation will touch any but the most superficial layers of anxiety.

In my early teens, I began a search for answers to this problem. It started with the questions that all good adolescents ask: Why are we here? Who am I really? What can be done about suffering? As a young man, this inquiry took me literally around the world as I met and had exchanges with a Zoroastrian high priest in Mumbai, a Zen master in Kyoto, fire walkers in Sri Lanka, and fakirs in Bali, as well as many of the leaders in the “consciousness” movement. One of my primary takeaways was that anxiety is fundamental in the human experience … and universally so.

This really caught my interest because I recognized the constant fear, sense of threat, and hypervigilance that seemed to be required to “survive” as not only overwhelming but as a fruitless way to live. Later, I channeled this interest into a career as a psychologist and devoted myself particularly to the study of anxiety. At some point in my search, I concluded that anxiety was not just fundamental, but the single greatest source of suffering in life — more central, even, than depression.

Over the years, my personal exploration and work with clients began to reveal certain repeating patterns about the fundamentals of anxiety. From this evolved a new model for treatment that has been gathering significant attention, not only for its effectiveness in treating anxiety but as a new therapeutic approach in general. It synthesizes several modalities, Eastern and Western, to deconstruct anxiety to its most elemental components. Positing a “basic anxiety” (cf. Karen Horney) as the underlying cause of our difficulties, the model pinpoints the precise moment and mechanism by which anxiety took root and altered our perception, creating a world of distorted and painful experience.

The model lays out what is in many ways a radically new understanding of the origin of anxiety, both in the individual and in the evolution of humanity. It describes the arrival of a “core fear” — one’s overriding interpretation of life as dangerous, and a “chief defense” — one’s primary strategy for protecting oneself from that danger. The core fear and chief defense create a singular dynamic that, according to the model, is the true wellspring of basic anxiety. Together, they open up a Pandora’s box of all our fear-based experiences, creating an anxious worldview.

The deconstructing anxiety model presumes that our original state of being is one of wholeness and fulfillment. But at a young age (and perhaps even in utero, as per Otto Rank’s concept of the birth trauma), we have our first contact with danger that establishes our core fear. Our mother leaves the room, and we think it is forever. Our father is distant and cold, and we are left wanting.

With the arrival of the core fear, we must choose a strategy for self-protection — our chief defense. This strategy, because it assumes “something out there is against us,” has us see ourselves as separate from the whole — from others, from what we need, from fulfillment. Armed with our chief defense, we embark on a quest to reclaim our original well-being.

Because this quest is motivated by fear (the fear of being separate from what we need), it can never succeed: With our focus on avoiding fear, our attention becomes consumed with all of the dangers that might sabotage our search. In this way, the core fear and chief defense become the original cause and perpetuator of our unhappiness. As a strategy to protect us from danger, they project our fears onto reality so that we may be “prepared” for them. This projection creates what I like to call a three-dimensional, multisensory hologram — a living, breathing perceptual distortion based on anxious premises. The great problem of human suffering is that we forget this is only a projection and take the hologram to be “real.”

Combining insight and action

What to do about this very human predicament? According to our model, we must thoroughly deconstruct our anxiety down to the core fear and chief defense that created the trouble in the first place. Only then can we see that they are made up of learned constructs, built from childhood assumptions that no longer serve us.

This sounds ordinary enough, but the model completely redefines what it means to perform such a deconstruction. It is only when we arrive at the “root of the root,” the original “mistake” in thinking (again, both in the individual and in humanity as a collective), that we can truly achieve the insight to show us that our fears are not founded. This depth of insight is rare. So often, we are mystified about why we suffer; despite our best efforts and insights, we become lost in the catacombs of unconscious fears, with no sure compass to direct our course.

Even if we do achieve true insight into the original thought of fear at the root of suffering, we may still need, as neuroscience shows, to take corrective action if we are to truly resolve anxiety. This is because fear can get written into our physiology in ways that insight alone cannot heal. Finding the correct action to take that will truly expose the illusion of our fear can also be challenging.

So, the right combination of insight and action is our goal. For this purpose, the deconstructing anxiety model has developed two powerful techniques that quickly reveal one’s core fear and chief defense. These diagnostic tools cut through our confusion and explain the original source of our suffering with comprehensive insight. Such insight suggests the necessary tools for action (also given in our model) to resolve the problem. Taken together, these practices help one get “behind the camera,” so to speak, that is projecting our individual and collective worlds of anxious perception.

Finding the core fear

The process of deconstruction starts with an exercise for finding one’s core fear called “Digging for gold.” With this technique, we may quickly and reliably reveal — or we may do so for our clients — the fundamental thought that has been distorting our perception for a lifetime. This exercise is the cornerstone of our model, using a process of deconstruction that goes directly to the root fear underneath all the rest. Here’s how it works:

Begin (or have your clients do so) by writing down a problem on the top left of a page. Any problem will do, because all problems are born, as we shall see, of the same core fear. Make sure your answer is stated as an actual problem and written in a short single phrase, such as “My friend slighted me” or “I can’t pay my bills.” Then write one of the following three questions on the right side of the same line of the page. Choose whichever of these questions seems most fruitful:

1) Why is that upsetting to me?

2) What am I afraid will happen next?

3) What am I afraid that I will miss or lose?

Answer the question with another short single phrase, written on the left side of the line below the first problem. This answer should state a new problem that brings you one level closer to the core fear underlying the original problem. Ask one of the same three questions on the right side of that second line and respond with a short single answer on the third line on the left. Continue with this process until you arrive at what you will clearly recognize as the core fear — a fundamental truth about the real source of the problem with which you started. (See box below for structure of exercise.)

You will know you have arrived at the core fear when you a) keep getting the same answer to the questions and can no longer find a deeper source of fear and b) have an “aha!” experience, a profound recognition that the answer explains something essential at the bedrock of your thinking. Spontaneous connections between the core fear and important events from the past will become apparent, sometimes accompanied by an evocation of powerful emotion and even catharsis.

The real significance of this tool, however, is that as you repeat it with various problems, you will discover that it reveals not only the root of a particular issue or issues but the one true root of literally any problem you can have. This is necessarily so because the core fear is your fundamental interpretation — the overarching assumption — of how the world can be dangerous or threatening. (Note: There are five core fears, or “universal themes of loss,” that capture the basic interpretations of danger that we all make. They are 1) fear of abandonment, 2) loss of identity, 3) loss of meaning, 4) loss of purpose and 5) fear of death, including the fear of sickness and pain.)

Because it is so threatening, so ego-dystonic with our previous state of wholeness, once we land on the core fear interpretation, it makes a powerful imprint on the psyche. We hold on to it as our key to survival — that which will make sense of the danger we’ve encountered and prepare us to be ready for it in the future. It becomes our new understanding of the world, the filter through which we will interpret every experience that presents (or that we can imagine might present) the possibility of danger.

Finding the chief defense

Once we have found our core fear, we must decipher our chief defense, defined as the primary strategy we use to protect ourselves from the core fear. Just as we do with the core fear, we cling desperately to the chief defense, believing it is necessary for survival. But in using this strategy, we unwittingly lock ourselves in to further anxiety because we are reacting to the idea of the core fear as if it were real, as if we are indeed in danger and our protective maneuvers are necessary.

As per the premise mentioned earlier, this is always a distortion of the truth. If we were to examine the real situation, we would at worst find a problem we can deal with rather than the catastrophe our core fear would have us imagine. More often than not, we find the situation we feared holds no threat at all — that the entire idea of danger was made up, a residue of childhood beliefs long held but never challenged.

To find the chief defense then, we simply ask ourselves, “How do I habitually respond to the core fear (or any threat to well-being, since all arise from the core fear)?” We have become so accustomed to our chief defense as our automatic (and only) response to problems that we don’t usually consider alternatives. But as a way to get perspective on our own presumptive response, we can ask ourselves, “How might someone else respond differently in this situation?” or “What is my typical response (overall) when I am challenged or threatened?”

We can also look at many of the major decisions we have made in life and how those decisions were designed to protect us from the core fear of those moments (e.g., the fear of making the wrong decision). There are several other methods for getting insight into one’s chief defense (complete descriptions of these practices can be found in my other publications), but all of them are really different ways of asking, “What is my personality style?” Because it is the core fear and chief defense that set our unique manner (our “personality”) of interpreting and responding to the variety of circumstances life can throw at us.

It bears repeating: The great discovery in this approach is that the core fear-chief defense dynamic gives a sweeping and comprehensive explanation about why we suffer. It not only builds our personality but outlines the entire way we have learned to orient to and interact with life. The extent to which we struggle is the extent to which we have not resolved these fundamental driving forces. Remember, even though they may take care of a problem in the moment, all defenses backfire in the end, reifying and exacerbating the problem they were supposed to protect us from. As we repeat these exercises over and over, we can demonstrate for ourselves that there is, in fact, one core fear and one chief defense operating behind the scenes whenever we are not experiencing the deep fulfillment and sense of wholeness that was our original state.

Once armed with insight into the core fear and chief defense, we are ready to take corrective action. The deconstructing anxiety model has developed several new techniques, including “The Alchemist,” “The Witness” and “The Warrior’s Stance,” for dismantling the chief defense and resolving the core fear. Each of these techniques has been demonstrated clinically to be highly effective in shaking off the hypnotizing effect of fear and waking us up to the truer reality it was hiding. Like pulling back the curtain in The Wizard of Oz, we “do the opposite” of what our chief defense would have us do, thereby exposing the core fear it was hiding. It is this unveiling of the core fear — the secret, primal source of our difficulties — that shows it to be ineffectual. It is but a mouse that roared, casting huge and grotesque shadows on the wall but carrying no real threat.

There isn’t space in this article to go into detail with these techniques, but each is designed to pinpoint the exact moment that our chief defense is applied. By targeting this moment, we may “do the opposite” and expose (rather than defend against) the core fear, revealing its true and distorted nature. But to do so, we must thoroughly move through the fear (at least in imagination) to “disobey” the command of the chief defense. This enables us to pull back from the automatic responses of our personality style, seeing them as arbitrary and encouraging a more effective reply. Combine this with the understanding that there is one core fear and one chief defense responsible for our way of being in the world, and these exercises give us the ability to unravel the entire world of projection that comes from them. It allows us to see through the appearance of danger and shows anxiety to be a lie — an optical illusion if you will — distorted by so much smoke and mirrors.

Case study

Peter (not his real name) was a 48-year-old man who suffered from generalized anxiety disorder. He was especially anxious about the idea of physical sickness and pain and of emotional rejection, and he struggled with the limitations of being human. It was evident from our first meeting that he had been raised by an overprotective mother who had shielded him too well from the exigencies of life.

When Peter was 9 months old, he became very sick and was hospitalized. In addition to the physical pain he experienced, he must have been terrified about being separated from his mother in a strange, cold environment with strange people poking and prodding him. When he returned to the security of his home, he regressed, clinging tightly to his mother and showing behaviors he had previously grown out of. He stayed young and dependent throughout his childhood.

At age 14, Peter began a tumultuous adolescence, experiencing his hormonal changes as an overwhelming challenge to his identity. His first response was to try to cling to his parents for comfort, but for the first time since his hospital experience, they were not able to calm him. This increased his anxiety all the more and solidified his core fear, which he described to me as being “exposed to the elements and to death, without any real security.” His response at age 14 was to make a powerful resolve that if his parents could not protect him, then he would find a way to gain a sense of control on his own.

As Peter grew older, this translated into various behaviors (what the deconstructing anxiety model calls “secondary defenses”) in which he would be “the best” at whatever he pursued: the best student, the best athlete, the most popular kid at school and so on. These behaviors represented his strategy for trying to reclaim the sense of safety and security he once knew. Putting these secondary defenses together, he described his chief defense (the umbrella description overarching them all) as “I have to be special.”

This response style would become Peter’s personality, following him throughout his life. Although it created a good deal of ambition in Peter — a drive to evoke his fullest potential — it was clear this drive was compelled by fear, a somewhat frantic need to be special. Therefore, it belied his anxiety of accepting the necessary limits of the human condition in a way that could have led to real growth and transformation. Instead, Peter felt stuck in a self-repeating loop that was the cause of his generalized anxiety — every time he became anxious, he would try in earnest to “beat” the problem, looking for the next way to prove his worth and “specialness.” Like any defense, this would provide momentary relief but then backfire, inevitably creating more anxiety when Peter was confronted with some new vulnerability, thus beginning the process all over again.

In our work together, Peter quickly uncovered his core fear and chief defense and developed a healthy appreciation for the futility of the strategy they proposed for well-being. With these insights in hand, we began the exercises for correction in the deconstructing anxiety program. In each, we gently but firmly confronted Peter’s chief defense of being special and practiced “doing the opposite.”

These exercises targeted the exact instant when Peter would defend against his core fear and provided a structure for safely and completely moving through the defense. In doing so, Peter could see the impulse to exercise his chief defense as an arbitrary choice. This allowed him to live through (in imagination) the full force of his core fear, coming to a deep acceptance of that from which he had been running his entire life. Sticking with this process, Peter’s chief defense “dissolved” (his word), no longer able to convince him that there was something threatening to defend against. He had faced his fear of not being special and relaxed into the fact that he was “ordinary, just like everyone else.” However, he no longer interpreted this as a source of pain or disappointment.

Quite the contrary, with a great look of surprise on his face, he stated, “It’s so freeing to be ordinary. I see how my whole life I’ve been working so hard to prove I’m special. All that did was keep me anxious, always worrying about failing at my goal. How ironic. I wanted to be special so I could get love and security. But I was the one keeping myself apart from that, thinking I had to be more than I was in order to earn that love.”

This is not an isolated example. Every time we face the core fear without the interference of the chief defense, we will find that the core fear is not “real” in the sense we had thought. This is the promise of deconstructing anxiety: When we clearly see the hidden forces that have been driving our lives, we can take those therapeutic actions that will set us free. This means moving through the chief defense that was hiding our core fear, exposing ourselves gently but firmly to the fear, and discovering that our core fear does not have the power to carry out its threat as promised. Even if a problem remains to be managed, it does not represent a true call for fear once the assumptions that made it frightening are stripped away.

What’s more, we find that the vast majority of our fears and anxieties are completely made up, projections built on ideas learned long ago that have no bearing on our circumstances today. This is the great key to freedom, a prescription for how to live our lives from a new premise — one based not on fear and anxiety but on the ability to consciously choose our way according to our highest ideals and deepest fulfillments.

 

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Todd Pressman is a licensed psychologist, author and speaker specializing in the treatment of anxiety and the pursuit of fulfillment. His most recent book, Deconstructing Anxiety: The Journey From Fear to Fulfillment, was published this past summer (see toddpressman.com for more information). Contact him at pressmanseminars@gmail.com.

 

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

Letters to the editor: ct@counseling.org

 

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