Tag Archives: stress & anxiety

Counselors weigh in on weighted blankets

Compiled by Bethany Bray April 16, 2021

The COVID-19 pandemic has been accompanied by a range of intense emotions, and for many people, this includes acute feelings of uncertainty and worry. It seems some people have tried using weighted blankets to find comfort, as sales have increased during the pandemic.

Manufacturers often tout the blankets as a nonpharmaceutical method to help quell anxiety, sleeplessness, stress, restlessness, unease and other symptoms.

A 2015 Journal of Sleep Medicine & Disorders study by Swedish researchers found that subjects with insomnia who began using weighted blankets reported improved sleep quality, being better able to settle down to sleep and feeling more refreshed in the morning.

In the realm of professional counseling, how do these claims stack up? Are these blankets truly helpful for symptoms of mental illness? Are practitioners and clients talking about the use of weighted blankets — and their possible benefits — in counseling sessions?

CT Online collected thoughts on the use of weighted blankets from professional counselors across the U.S. Add your experience in the comment section at the end of this article.

 

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The challenge to weighted blankets is that they provide physical weight but not the compression or true pressure that many with attention-deficit/hyperactivity disorder (ADHD) and autism may be seeking. Although many people do report that a weighted blanket assists in reducing their overall stress and allows more effective sleep, I believe the question really should be: Does the weighted blanket actually create those improvements, or are the reported positive changes actually due to the weighted blanket causing us to sit still for a little bit?

This slowdown during our typically fast-paced day might be a significant reason so many of us truly believe that weighted blankets help. Trend or not, I think weighted blankets show true promise in helping people learn to be more mindful of their busy lives.

I have found that weighted blankets appear to provide minimal benefits to kids with ADHD or autism. Although many of the kids I work with do enjoy the weight, parents nor children typically report significant benefits. In fact, although a large number of my families have purchased weighted blankets, very few use them on any consistent basis. I believe this is due to the concept of weight versus compression.

Although the weight can feel good, for the kids I work with, it does not provide enough sensory input to make a difference. Instead, they often seek compression or pressure.

Although weighted blanket [retailers] often talk about the “pressure” it provides, the difference is in the details. It does provide pressure, but not the deep pressure that many with ADHD or autism are seeking in times of dysregulation. In fact, kids with tactile and or proprioceptive sensory behaviors often seek out deep pressure to help regulate their nervous system. This means they often need more than what a weighted blanket can provide.

I have found that my kids who do like weighted blankets use all the weighted blankets in the house and they are oftentimes using three or four weighted blankets at once! This means the weight they are seeking is much higher than the 10% of their own body weight [that is the recommended guideline].

Although weighted blankets are definitely a trending item, I fully believe they are here to stay. However, they will probably be most useful for those who like to sleep with extra blankets purely because they like the [feeling of the] weight. For everyone else, I think compression items are often the way to go.

  • Michelle Tolison, a licensed clinical mental health counselor and owner of Dandelion Family Counseling in Charlotte, North Carolina. A registered play therapist, she works with children who are twice-exceptional (particularly those with ADHD).

 

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As a child therapist, I’ve long known that occupational therapists use weighted blankets to help children with sensory issues and anxiety, including children with ADHD and autism spectrum disorder. These blankets have moved into the mainstream, but just because they’re popular does not mean they can be used to help children without first consulting a medical doctor or an occupational therapist.

A weighted blanket provides deep pressure to the body, which can help induce relaxation. However, there are physical safety concerns when it comes to children and weighted blankets. They shouldn’t be used on a child younger than 2 years old. The child needs to be able to remove the blanket themselves, and their head should never be covered. If the pellets fall out of the blanket, they can be a choking hazard. Parents should always supervise their child when using a weighted blanket.

The American Occupational Therapy Association advises against sensory-based interventions, such as weighted blankets, unless children have been thoroughly assessed. In my opinion, professional counselors are not trained to provide sensory assessments nor suggest sensory-based interventions. Suggesting a weighted blanket as an intervention for a child would be outside of the scope of our practice and could be considered unethical.

If a parent has concerns about their child’s anxiety, hyperactivity, autism, sensory processing disorder, or just an inability to go to sleep and stay asleep, I encourage them to speak to their pediatrician before they utilize a weighted blanket. Their pediatrician may recommend an evaluation by an occupational therapist.

  • Pam Dyson, a licensed professional counselor supervisor and registered play therapist supervisor in Spring Hill, Tennessee, who offers virtual play therapy supervision and consultation services.

 

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During the COVID-19 pandemic, there’s no doubt that mental health symptomology is on the rise, most commonly anxiety and depression, but also for people diagnosed with autism and ADHD, since it seems to be much more of a struggle to regulate one’s emotional/behavioral state during these uncertain times. Interestingly enough, it’s also been noted that the sales of weighted blankets have increased during the pandemic. Coincidence? I think not.

Adding weight/pressure to our large muscle groups (with a weighted blanket) activates the body’s proprioceptive sensory system. Activating this system increases both dopamine and serotonin in the brain, helping people to feel more emotionally regulated, calm and in better control of their emotions and behaviors.

Dopamine is our main “feel good” neurotransmitter and main “focus” neurotransmitter. When there is an insufficient amount of dopamine being produced, retained or transported, it’s like there is a “reward deficiency syndrome” occurring. Therefore, the brain requires increased stimulation to obtain a sense of satisfaction/reward, which can be seen in the hyperactive response of those with ADHD or autism when they sensory-seek (spinning around and around) or when they novelty-seek (hanging over a two-story banister). Due to these struggles, they tend to seek excessive proprioceptive input with the intention to calm their nervous systems — but in maladaptive manners. Their excessive movement can come across as chaotic to themselves and disruptive to others.

During a pandemic, with an increased amount of time at home and without the full structure of school, clubs, organized sports, etc., that in itself can cause these symptoms to increase. A weighted blanket can assist in the retention of dopamine so these people don’t need to seek stimulation in such maladaptive manners and therefore can remain more in control of themselves. This means that a weighted blanket can be beneficial for people with autism and ADHD who have difficulty planning their movements and regulating their level of arousal. When they feel pressure from a weighted blanket on their large muscle groups, it can actually give them this proprioceptive input in a more organized manner, leading to increased attention, less internal chaos and less disruption to others.

Serotonin is a neurotransmitter that helps soothe us when we feel stressed. Serotonin is also involved in our survival mechanism to help regulate our sleep, food cravings/appetite and sexual desire. It’s involved in memory, mood/irritability levels and sensitivity/insecurity/self-confidence levels. With an insufficient amount of serotonin being produced, transported or retained, people tend to feel anxious, irritable and can have difficulty sleeping. A weighted blanket can add proprioceptive input to help retain serotonin in the brain, so one can feel calmer, soothed and more self-confident and self-secure.

Physical containment from a weighted blanket can help facilitate emotional containment [and] a sense of stability and promote behavioral regulation. (Think about it as a similar concept to “swaddling” a baby to soothe them when they are upset and to help them sleep.) It’s no wonder that the sales of weighted blankets for children and adults are on the rise during a time of uncertainty.

  • Donna Mac, a licensed clinical professional counselor at a school in the Chicago area that specializes in helping students with emotional disorders, higher-functioning autism, secondary learning disabilities and other health impairments.

 

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More than one client has reported an improvement in their sleep after using a weighted blanket (or even multiple regular, heavy blankets if they couldn’t afford a weighted one) at home to give them a sense of pressure. Given all that we know now about how trauma impacts the body, it makes a lot of sense to look at as many sensory modalities as possible when working with this population.

As a personal anecdote, I have a nephew on the autism spectrum, and there was a dramatic change in his behavior after he started using a weighted blanket to improve his sleep quality at night. I do realize that the plural of anecdotes is not data, but I’ve certainly had enough positive feedback from people to suggest it to clients as an option to explore.

  • Kirsti Reeve, a licensed professional counselor at a group practice, Transcendence Behavioral Health, in Royal Oak, Michigan. She specializes in working with self-injury, teens and trauma and is also a certified drug and alcohol counselor.

 

 

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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.

COVID-19 and the ‘casino effect’

By Todd Monger April 15, 2021

Providing mental health services during a pandemic is a perspective changer. A few weeks ago, I happened to work with three clients back-to-back, providing counseling services through telehealth. COVID-19 has opened a door, and a necessity, to being creative in how we provide services and mental health support. It has also revealed an interesting parallel.

As I worked with these three college students who were struggling with issues related to depression, isolation, lack of energy and anxiety, I realized they were all engaging in counseling from the same environment: a basement or bedroom from which they had not left the entire day. Not because of the debilitating effects of a clinical diagnosis, but rather because they had no need to.

It is well known that casinos spend significant resources honing the psychology of their gambling venues to tap into the gamer’s five senses. Casino designers create an environment that lulls their customers into a trance during which they can lose their financial capital as quickly as they lose their sense of joy, self-esteem and inner peace. There are no clocks or windows. Scents are used that research has shown can increase gaming up to 53%. Customers are well-stocked with free drinks and snacks. All of this is done with the purpose of encouraging gamers to pull that lever or roll the dice one more time.

It has occurred to me that COVID-19 has had some similar effects on our psyches. If recognized, we might use these observations to inform our understanding of some of the mental health pitfalls that our clients are currently experiencing, similar to the way we are informed of the trappings of organized gaming.

Time

Casinos work hard to keep customers hooked to their games. One way this is done is to remove anything that informs the player of time. Clocks and windows are almost never seen because these objects would risk informing those on the gaming floor that they have been there too long or have other things that need their attention.

The coronavirus demanded that many of us work or attend school from home. It has become apparent that our living conditions can affect our mental health in ways we do not readily recognize. Many people’s workstations reside in dark bedrooms or basements in which natural light is limited or eliminated completely. To improve contrast and reduce screen glare, those who are working or attending school from home may draw their curtains. The information that daylight provides about the time of day — morning, noon, night — is effectively lost.

It used to be common to get our news and entertainment via predictably scheduled TV shows and movies. Some even carried time stamps (the 6 o’clock or 10 p.m. news, for example), prompting us to consider our proximity to bedtime. Now we stream our news and television shows with little thought given to a set schedule. We routinely engage in “binge-watching,” which is akin to staring at a slot machine as it rolls around and entices us with “just one more pull” before we go (and then still don’t leave). Whether it was beating rush-hour traffic, catching a school bus, coming home from work or attending evening activities, these actions subtly informed us about the time of day and regulated us biologically, providing a healthier existence until the threat of COVID-19 arrested these tells.

COVID-19 is affecting our sense of time and, as such, impacting our biological regulation of sleep, diet and exercise — three ingredients that can help either protect us against or make us more susceptible to depression and anxiety. For these reasons, I recommend that individuals pay greater attention to their work and entertainment environments. Set structures that encourage relocation and movement. Although it is potentially less convenient, consider watching your entertainment on a different screen and in a different room than where you work or sleep.

Maintain morning rituals and evening activities that help inform what needs to be happening at each point in the day. Consider investing in a dawn simulator alarm clock, and be mindful of the sunrise and sunset and how they can be included in one’s daily schedule. Committing to a balanced and regulated lifestyle during the pandemic will promote improved mental health, rest and rejuvenation.

Comfort

If you want to help a person lose their money, or their mind, keep them as comfortable as possible. Casinos provide free food and drinks, with incredible customer service, so that gamers never feel the pressure to leave. It’s a sedentary existence to sit at a slot machine or a card table as it eats away at hard-earned resources.

In a somewhat similar fashion, the COVID-19 pandemic has restricted us to our living areas. At first, this was a celebrated comfort for some — easy and seemingly weightless. Those few extra minutes in bed. Never having to get out of your sweatpants. Your living room becoming your office, your entertainment center and your bed. Days and weeks can go by as groceries are delivered to one’s house.

Suddenly, leaving home for any small amount of time feels like a chore or, worse yet, home has become a security blanket and leaving becomes anxiety producing. The more comfortable we are, the more everything else seems like “work” — and certainly less pleasurable.

Metaphorically, I have thought of this as being akin to an astronaut whose “antigravity muscles” (neck, calf, back) begin to atrophy due to underuse after five to 11 days in a weightless environment. Upon returning to Earth, gravity suddenly feels like a heavy weight, and what previously seemed normal is now crushing, unpleasurable and anxiety producing. To mitigate these known effects, astronauts intentionally exercise every day while in outer space, using resistance bands and other adapted machines to keep muscles working.

In a similar way, individuals need to keep working out their social and mental muscles. I fear that when the COVID-19 pandemic is finally over, some people will struggle with the “gravitational pressure” of social engagement because that muscle has atrophied through underuse during this time of physical distancing.

Mental stimulation

Casino floors are loud. Between the lights, colors, bells, sirens and laughter, it’s little wonder they are often referred to as “playgrounds.” Upon first entering such a place, it seems filled with possibility and excitement, but it doesn’t take long for that sound to become numbing. Research on gaming design tells us that casino games are made to “sound like winning” to increase a person’s drive to engage. Casinos, from the games to the artwork, are designed to draw one in like a moth to a flame. I imagine this is similar to receiving a “like” on a social media account, the new dopamine hit of the 21st century.

It is no surprise to hear that living through COVID-19 is boring. So many people and places we took for granted have been taken away or locked down. The world has been filled with fear, and in many cases, technology has been the answer to keep us safe.

As we continue to use our digital “slot machines” to connect to the world around us, one unintentional effect is that we steadily increase the amount of access we have to passive, yet exciting, communication. It reminds me of learning how food can become a delivery system for sugar, which tastes delightful and delivers an immediate energy rush, but leaves one feeling tired and sluggish soon after. And when we feel tired, we consume more sugar for a quick pick-me-up, resulting in a vicious cycle. Under the COVID-19 pandemic, when our brains feel bored, we are tempted to watch more lights, more colors, more bells to stimulate away the silence and isolation. Much like in a casino, this can trick us into feeling like we are winning when, in reality, we are running ourselves into the ground due to a lack of true novelty.

Dopamine, sometimes referred to as the pleasure neurotransmitter, is actually increased when we think of or engage in something that is novel. Technology can be an amazing delivery system of novelty. However, during this time, it is important that we also find novelty outside of the “casino.”

I have challenged clients to create their own journals titled “Things I learned during COVID-19” and then fill them with experiences, activities and photos. Creating novelty does not have to be hard. It can be as simple as making your own campfire and toasting s’mores, cooking or baking, or learning something new. The process of both planning and physically doing new tasks increases movement and engagement and uses our entire neuro-network to improve mental health. The process of delayed gratification —thinking about something exciting or interesting in the future —also increases dopamine.

Living life in a pandemic is challenging in so many ways. But if we allow it to, it can also birth creativity, intentionality, resiliency and new insights. Even though we find ourselves wandering around our homes in a seemingly numb state at times, it does not have to mean that “the house always wins.” My encouragement to you and those you love is to close the laptop or smartphone, get up from the bells and whistles, step away from the artificial lights, and walk outside to reconnect with a world that is missing you.

 

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Todd Monger is a licensed professional clinical counselor, national certified counselor and approved clinical supervisor who has been providing clinical services for 20 years. He currently serves in private practice at Stable Living LLC, where he provides equine-assisted psychotherapy. He has also served as the executive director of student development at North Central University in Minneapolis for the past 17 years. Contact him at todd@stableliving.us.

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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.

Money on the mind

By Laurie Meyers April 7, 2021

Money is the dirty little secret of American society. The unspoken social contract is that, like Voldemort, it shall not be named. We may joke about winning the lottery, but we don’t reveal the strained financial circumstances that underlie that pipe dream. Modern life is not cheap. Unfortunately, many workplaces and professions do not reflect this reality. Could we be making more money? Who knows? Many companies forbid their employees to discuss salaries with co-workers.

Meanwhile, our consumerist culture makes it easy for money to fly out of our wallets and onto our credit cards. Financial experts (some of whom sound a bit like scolds) urge us to maximize our contributions to our retirement plans and have savings sufficient to sustain us for six months or more of unemployment. These are worthy goals, but most Americans find them challenging to achieve.

A 2019 survey by the personal finance company Bankrate found that approximately 28% of Americans had no emergency savings and only 18% had enough to live on for six months. And a 2019 report by the U.S. Federal Reserve revealed that 25% of nonretired workers possessed no retirement savings at all. Surveys show that a large share of Americans — including those who earn higher salaries — live paycheck to paycheck. Many people get by with the help of a credit card — or three or four. A recent poll by CreditCards.com showed that almost half of Americans (47%) currently carry credit card debt. And even though being in hock to credit card companies is so common, carrying that kind of debt is still associated with a lack of financial responsibility. 

Just set a budget! Track your spending! Stop buying that daily Starbucks latte!

It’s not the latte. And the one-size-fits-all financial advice on offer by cable talking heads and in best-selling books doesn’t typically work. Not just because people’s financial obligations are different, but because managing money isn’t only about the numbers. The way we spend — and save — is tightly entwined with emotion and driven by learned behaviors and beliefs whose existence we are frequently unaware of, according to experts who study neuroeconomics. These factors can prevent us from effectively managing our money.

The mental health consequences of financial difficulties can be significant. Even before the recession caused by the COVID-19 pandemic, Americans frequently rated financial worries as one of their top sources of stress. This past October, the fourth in a special pandemic-oriented series of “Stress in America” surveys from the American Psychological Association revealed that nearly 2 in 3 adults (64%) said money was a significant source of stress in their lives.

Financial difficulties can cause stress and depression. Stress and depression make it harder to tackle money problems. It becomes a vicious cycle — particularly for those who are already living with mental health problems.

Enter financial therapy, which the Financial Therapy Association (FTA) defines as “a process informed by both therapeutic and financial competencies that helps people think, feel, communicate and behave differently with money to improve overall well-being through evidence-based practice and interventions.”

Financial therapists primarily come from the mental health, coaching and financial fields. Some of them are mental health professionals who realized that money plays an important role in overall well-being and decided to become trained to offer financial therapy in addition to their regular practice. Others are financial professionals who realized that they needed to be able to handle the emotional aspects of money and received additional behavioral training or, in some cases, became licensed mental health practitioners.

All of the sources Counseling Today spoke to for this article are licensed counselors who offer financial therapy to existing clients who express interest or as a stand-alone service. They use a variety of tools to help clients understand their internal money narratives, identify behavioral patterns, and process the emotions that are getting in the way of setting and working toward their financial goals.

The field developed out of a body of research on neuroeconomics. Psychologists Ted Klontz and Brad Klontz and financial planner Rick Kahler are widely considered the “grandfathers” of financial therapy.

Early lessons learned

Research by Klontz, Kahler and Klontz suggests that people begin developing money beliefs — and potential future problems — in childhood. These attitudes are often developed through experience and observation rather than parental instruction.

That’s because many families don’t talk about money, notes American Counseling Association member Elaine Korngold, a licensed professional counselor in Portland, Oregon. Children grow up in families not knowing how much money their parents make, how much (or how little) different jobs pay, and what level of income is necessary to cover basics such as rent/mortgage, utilities and food — let alone how to set up and follow a budget, she says.

Although parents usually talk about and teach their children essential life skills such as driving, anything to do with money is often kept secret, says Korngold, who worked in the financial sector before she became a counselor. This not only leaves children uninformed and unprepared but also reinforces the societal perception of money as a taboo topic. As a result, many adults who struggle to manage their finances simply don’t know how to seek help or are too ashamed to ask for it, she says.

But even when parents don’t explicitly teach their children about money, they are still imparting lessons, says Kathy Haines, an LPC in Marietta, Georgia, who is training to become a certified financial therapist through FTA.

An integral part of Haines’ financial therapy process is exploring the financial beliefs held by a client’s family of origin. Haines, an ACA member, asks questions regarding whether money was ever discussed, who managed finances in the family and how. “Were there fights about money?” Haines asks. “Spoken or unspoken messages such as don’t have credit debt? Work hard so that you can take care of yourself?”

Similarly, Korngold asks clients about the spending behaviors they observed growing up. Did it seem like the family was always just making it until payday, or was there any financial cushion? If the family found itself with more money than usual, what did they do with it? Put it in the bank? Take a vacation? Buy a TV?

Jennifer Dunkle, an LPC in Fort Collins, Colorado, whose specialties include financial therapy, asks her clients to write their “money story” by answering a variety of questions: What are your earliest memories concerning money? What did you learn from your family about money? Specifically, what did you learn from your father? From your mother? What experiences did you have with money as a young adult?

These messages and experiences contribute to what Klontz, Kahler and Klontz call “money scripts” — unconscious beliefs that shape our financial behavior.

Money narratives

Dunkle, like many financial therapists, also gives clients the Klontz Money Script Inventory (KMSI) assessment.

“Most adult money scripts are based on earlier life experiences,” she says. “In order to make lasting changes to budgeting, spending, savings and investing plans, it is very helpful to learn more about our underlying beliefs and values in regard to money.”

The most common money scripts include beliefs such as:

  • More money will make things better.
  • Money is bad.
  • I don’t deserve money.
  • I deserve to spend money.
  • There will never be enough money.
  • There will always be enough money.
  • Money is unimportant.
  • Money will give my life meaning.
  • It’s not nice or necessary to talk about money.
  • If you are good, the universe will supply all your needs.

Dunkle explains that Klontz, Kahler and Klontz group money scripts into the following types:

  • Money avoidance: Avoiding dealing with money and rejecting personal responsibility for one’s financial health.
  • Money worship: Believing that a financial windfall or increased income will be the solution to all of one’s problems; being focused on the inward value of the accumulation of money.
  • Money status: Being overly concerned with the idea that self-worth equals net worth; believing that money conveys status; wanting to always have the next new, big-ticket item; and being interested in the outward display of one’s wealth to others.
  • Money vigilance: Being watchful, alert and concerned about one’s finances. Those who are money vigilant are much less likely to avoid their financial matters, overspend, gamble and engage in financial enabling.

Klontz, Kahler and Klontz say that the scripts themselves are not “good” or “bad.” Rather, they are simply indicators of behavioral influences.

“For example, someone who has the belief that ‘I deserve to spend money’ might run up a lot of credit card debt despite not being able to actually afford their purchases,” Dunkle explains. “The script, ‘It is not nice or necessary to talk about money’ could lead to money secrets between spouses. Believing that ‘If you are good, the universe will supply all of your needs” may result in not doing adequate planning and saving for retirement.’”

Working toward change

Dunkle uses motivational interviewing to help clients recognize the adverse effects their financial habits are having on their lives.

“The goal of motivational interviewing in financial therapy is to elicit ‘change talk’ by using the skills of open-ended questions, affirming, reflective listening and summarizing,” she explains. “When clients hear themselves talk about potential changes, they start to believe that change is indeed possible. For example: ‘Getting my finances under control would help me sleep so much better at night.’”

To facilitate the process, Dunkle might ask someone who is money avoidant an open-ended question such as, “What is that like for you, seeing those unopened credit card statements pile up on your desk?”

For someone whose script is money worship, she might make an affirming observation such as, “It sounds as though working 70 hours a week in order to earn more income is really starting to get to you. It’s no wonder that you feel worn out.”

With a money status case, Dunkle says she could listen and reflect back by stating, “What I hear you saying is that you believe that your value in the family comes from showing your relatives how much you earn and how much you own, not from who you are as a person.”

For a client whose script is money vigilance, she might observe and summarize with a statement such as, “Wow, it sounds as though you feel exhausted, thinking that you need to check your accounts every night before you can relax and go to sleep.”

Haines also uses the KMSI as one of her tools for uncovering the narratives that drive clients’ financial behaviors. She breaks down narratives into thoughts about skills or situations and core beliefs about worth.

“Step one for both is to become aware of those narratives,” Haines says. “This can be difficult because they run so quickly in the background that we often don’t even know they are informing our behavior. Slowing down and becoming curious about our own thoughts and beliefs can be difficult, but [it] is a necessary first step.”

Haines asks clients to write down their thoughts — which she reminds them are not facts. When reviewing their collection of thoughts and beliefs with them, she asks clients to consider the following questions:

  • “What leads me to believe this is true? Is it from my own personal experience or maybe from some other influential person in my life who has told me this?”
  • “Is it always true? Is there evidence to the contrary?”
  • “If I can’t see evidence of it being true, can I hold the possibility that it’s not true?”
  • “If there is evidence of it not being true, how are those instances different, and how can I intentionally bring more of that?”

For example, many clients believe that they will never be able to manage money, Haines says. “I would ask, ‘What leads you to believe this is true? Are there instances where you have made good financial decisions that align with your values and what you want? What was different about those times? What prevents you from doing more of that? Are there skills that you need to learn? Do you need to ask for help? Is there fear involved?’”

“Once we go deep into the genesis and meaning of the narrative, it can go in any direction,” Haines says.

When a client’s narrative is about worthiness or “deserving” something (such as money or a higher paying job), Haines uses a similar, but less structured, process. “I usually ask those clients to slow down, take a few breaths, close their eyes and ask internally, ‘Whose voice is this?’ Is it yours, or is it someone else’s?” Haines notes that it is almost always someone else’s voice, such as a parent or caregiver or another figure who holds meaning for the client into adulthood.

“We then will unpack whatever comes up,” she says. “I might suggest that those who gave [the client] the message of unworthiness around something — either directly or indirectly — were struggling with their own sense of self and meaning in the world and [it] has absolutely nothing to do with my client.”

“I often will use the visual of newborns in a hospital nursery,” Haines continues. “Are some of those newborns born worthy and others unworthy? This helps them to see that feeling unworthy of something is just an internal narrative, not an absolute truth. I might ask, ‘What will it take for you to feel worthy? How will you know when you are worthy? Think of someone you care deeply about. Now decide when and what they are worthy of.’ That usually feels really uncomfortable for them [the client]. Then I reflect back that’s exactly what they are doing to themselves.”

Haines adds another common belief about money and success is that people who are rich are greedy and achieved that higher position because they didn’t care what they had to do to get there. “In essence, not having integrity,” she continues. “I have seen this a lot. An individual feels strongly about honesty, integrity and not being greedy. They want to succeed, but the people in the positions they want don’t seem to personify integrity. So, the position is out of alignment with their values, and their behavior will not support moving up. We then work on how they can create their own visual of how to be in that position from a place that aligns with their own values.”

Where does the money go?

Overspending is a problem that financial therapists see frequently. Clients show up at Haines’ office wondering why they are always in debt despite making an adequate salary. She helps clients identify what kinds of things they are purchasing and why.

“I’ve had clients who wanted to participate in getting together with friends, perhaps for dinner and drinks, concerts, plays, etc.,” Haines says. “They couldn’t really afford to do these things, but as humans, our need for belonging is so strong that we will do almost anything to fit in. I try to help my clients identify what they get out of these activities. It may be good conversation, advice, laughing together, intellectual stimulation or just not feeling lonely. We then brainstorm other ways to get these needs met, but without having to spend money they don’t have.”

“For instance,” she continues, “instead of expensive dinners, they could meet for coffee and have the same connection and conversation without the cost. If it’s intellectual conversation, maybe starting a book club. One idea that came up was to meet at a park and bring a lunch. The atmosphere is better than a restaurant, and it doesn’t cost anything.”

A possible downside is if the clients’ friends don’t want to make those changes. Then comes the difficult decision of whether the client will commit to living within their means and risk losing the relationship(s) or continue to overspend and remain in the safety of the relationship. This adds another layer of exploration about whether those relationships are, in fact, healthy and reciprocal, Haines says, but the overarching theme remains identifying what those dinners or other expensive activities are providing to clients and how some of those needs might be met in other ways.

“I will add that knowing and having a visual of the ‘why’ [the necessity] of changing financial behavior is always present,” Haines says. “Coming back to that assists with getting over the hurdles of change.”

“Keeping up with the Joneses” is another common spending impetus. Society encourages competition, such as having a nice car just because “everyone else” drives a nice car. But Haines asks clients if that really fits their core values.

“If you value a nice car and if you have one, that’s great, but if you buy a nice car because everyone in the neighborhood has a nice car, that’s going to create turmoil,” she says. For Haines, financial therapy is all about helping clients achieve what they want, not what other people think they should want.

ACA member Edward Kizer, an LPC whose specialties include financial therapy, says many of his clients are aware that they are engaging in compulsive shopping as a method of self-soothing or self-care. He teaches them simple techniques such as belly breathing to reduce their anxiety and also asks clients to think about what shopping gives them.

“If I’m expressing a need through retail therapy, what is that, and how can I feed that?” he asks. “What feeds you? Is it being creative? Is it the outdoors? How do [you] get back to nurturing yourself?”

Impulsivity is a significant driving factor in compulsive spending, says licensed professional clinical counselor Denise Kautzer, who is also a certified public accountant and specializes in financial therapy. She has clients track their spending and encourages them to follow the “24-hour rule,” which involves waiting for 24 hours after seeing something that they want to buy. In the end, they may still end up purchasing the item after giving it more consideration, but adopting this approach cuts down on impulse buys, she says. In addition, because spending often makes people feel good, at least temporarily, Kautzer helps clients identify other things that bring them joy.

Seeing the whole picture

Clients can’t manage their money if they don’t know where it’s going — or where it’s needed. Part of the financial therapy process is identifying expenses and assets: money in and money out.

Brian Farr, an LPC in Portland, Oregon, whose specialties include financial therapy, introduces what he calls a “snapshot” in the first session. “It’s a simple expenses and income and debt worksheet, not a budget or spending plan. Just a snapshot of what a typical month looks like,” he says. “It’s to help introduce them to the reality of their household finances.” Farr’s clients tell him this exercise helps give them clarity and motivation.

Like the other financial therapists Counseling Today spoke to for this article, Farr does not see himself or offer himself to clients as a financial planner. Instead, he helps clients understand their finances and develop a system to help them meet their goals.

“The freedom around money is coming up with some method that makes it visible,” Farr says. Once clients have that picture, he helps them be realistic about what they can and cannot do. That involves identifying how much money comes in and then giving each dollar a “job.”

He finds the youneedabudget.com website useful because it offers helpful videos and allows people to categorize not just their everyday expenses, but also infrequent but large expenses such as holiday gifts, a pet’s yearly checkup at the vet or car maintenance. Clients can then look at the money coming in and evaluate where it needs to go.

“If 60% already has a job to do, stop thinking that it’s yours to do with what you want,” Farr tells clients. He advises them that when they know how much of their money is discretionary, then they can make more realistic choices.

Asking clients about financial health

Many counselors don’t like asking about money. In fact, several of the professionals interviewed for this article noted that counselors often fall under the “avoidant” category when it comes to money scripts. But financial therapists say that it’s essential for counselors to be aware of money stress.

“We all have money stress,” Haines says. “I don’t know a person who doesn’t have money stress at some point in their lives. … It affects everybody.”

Counselors need not create an elaborate process to uncover a client’s money worries, Haines says. “It could be as simple as putting a question on your intake form such as: Are there financial concerns that are impacting you?”

Haines also urges counselors to listen for nuggets of information, such as clients mentioning that they hate opening their mailbox because it’s always full of bills. “You can just ask the question, ‘What impact does that have on you?’” she says. Money troubles are something that most people don’t talk about, even with their friends, so counselors can serve as that trusted person clients share those fears with, Haines emphasizes.

Haines and Kautzer both say that one of the most critical parts of their work as financial therapists is giving people hope.

 

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Laurie Meyers is a senior writer for Counseling Today. Contact her at lmeyers@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.

How COVID-19 is affecting our fears, phobias and anxieties

By Lindsey Phillips March 2, 2021

When faced with a new, unknown virus, our anxiety can take over, and we often assume the worst. We indulge our fears. We panic. The uncertainty overwhelms us, exacerbating old anxieties and fears and creating many new ones.

If this reaction sounds familiar, you were likely alive when HIV, the virus that causes AIDS, elicited widespread fear and anxiety in the 1980s. In fact, the HIV/AIDS and new coronavirus/COVID-19 outbreaks share many similarities: an inadequate government response, the stigma attached to having the virus, the disproportional impact on underrepresented groups, and initial confusion over how the viruses are transmitted.

At the onset of the AIDS crisis, people incorrectly assumed that they could get HIV by kissing another person. Michael Soderstrom, a licensed professional counselor at Houston OCD Counseling in Texas, remembers his own anxiety when first hearing about HIV and AIDS. He says he didn’t want to sit on a public toilet for fear of contracting HIV.

There’s no doubt that the COVID-19 pandemic has changed us. The question is, in what ways will it continue to change us? Will we ever shake hands again? Will we wear masks each year during flu season? Will we learn from the lessons of previous health crises? One thing is clear already: The pandemic is reshaping not only people’s fears and anxieties but also how counselors are having to approach treatment.

Fear of contamination and harming others

What about people who wrestled with contamination fears before this pandemic? Have they experienced an increase in symptoms? Soderstrom, an American Counseling Association member who treats obsessive-compulsive disorder (OCD) and other anxiety disorders, has observed that his clients who fear contamination from blood, semen or bodily waste have not gotten worse, because quarantine largely takes them away from exposure to these “contaminants.” But he has noticed an increase in clients who worry about contracting diseases, getting sick or dying, as well as those with perfectionist tendencies who struggle with the fact that COVID-19 ultimately lies outside their control. The thought that they could contract the disease regardless of how carefully they follow safety precautions terrifies them, he says.

The pandemic has even given rise to a new phobiacoronaphobia, the fear of contracting COVID-19.

People with OCD are also at risk of backsliding right now because the isolation, heightened stress and uncertainty associated with the pandemic can lead to depression and generalized anxiety, which fuel OCD-related symptoms, says Soderstrom, a member of the International OCD Foundation and OCD Texas. He has seen several new clients who had previously dealt with OCD symptoms on their own, but their symptoms became unmanageable during the pandemic, causing them to seek professional help.

To some degree, everyone is concerned about cleaning and sanitizing right now, so when do these thoughts and behaviors cross over into becoming a problem? Soderstrom asks clients who struggle with contamination fears to establish a safety practice based on guidelines from a trusted health organization such as the Centers for Disease Control and Prevention (CDC). He also has clients record how often they are cleaning surfaces to help them recognize if their behavior is becoming problematic.

If clients realize they are going beyond the CDC guidelines and washing their hands obsessively, Soderstrom has them establish rules on when they should wash their hands, such as after using the bathroom or sneezing. He also encourages them to limit themselves to washing with soap and water for 20 seconds. At first, these clients may feel the need to also wash their hands every time they touch the front door because it could be contaminated. Over time, Soderstrom may ask them to simply “water wash” their hands after touching the front door. This fulfills their emotional need without the full brunt of soap and water. These ground rules serve to keep people anchored in reality because someone who wants certainty can always find a reason to wash or clean, he adds.

Soderstrom has also noticed an increase in clients who worry about infecting others with the coronavirus. These clients struggle with what is known as “harm OCD”; they are the same people who worry about hurting or killing someone with their actions, he explains. To illustrate, these clients might grab a doorknob and think to themselves, “I hope I have the COVID-19 virus and will give it to my mom.” But then they quickly reject this thought and obsessively clean the doorknob out of fear that they will actually give their mother the virus.

Over-responsibility is a substantial issue with OCD, Soderstrom continues. Some clients feel responsible for not protecting others from the coronavirus, so they are constantly cleaning commonly touched surface areas such as car-door handles before others use them.

With these clients, Soderstrom often uses a responsibility pie exercise. If a client is worried about giving their older parent the COVID-19 virus and killing them, then he would ask, “What are all the other ways they could get COVID-19? How many times have they been to the store? How many times have other people come over to their house?” This exercise helps clients realize that assuming full responsibility for the possibility that someone else could get COVID-19 is not realistic, he explains.

Soderstrom also finds this exercise personally helpful. Whenever he has intrusive thoughts about the possibility of getting COVID-19, he asks himself, “What ways could I get the virus? If I did get the virus, who would be responsible — me, the government or the people I’m around?” Thinking through these questions helps him realize that even if he did get COVID-19, it would not automatically mean that he had been irresponsible or was a failure. Because myriad factors are at play, he knows he can only do the best he can to stay safe; the rest, ultimately, is outside of his control.

Relationship and separation anxiety

In the coming months, Rocio Morris, a licensed mental health counselor and the assistant clinical director at the Bougainvilla House in Fort Lauderdale, Florida, believes counselors will see an increase in relationship issues. She has already noticed that more of her clients are coming to therapy because of attachment and communication issues within the family. For example, one of Morris’ clients is in a codependent relationship with her mother, and the mother’s anxiety over the pandemic is in turn affecting her. The mother constantly worries about the family contracting the virus, which only serves to increase the daughter’s anxiety.   

In addition, a few of Morris’ clients are having identity crises because they are isolated and trying to figure out who they are in the absence of their normal support networks. One client in particular is actively grappling with her sexual orientation, but she is doing this alone in a home with a mother who is unsupportive and two young siblings. Before the pandemic, this client would have found support through school activities or by hanging out with friends who were having similar experiences. Now, she feels trapped and all alone in her house.

To complicate matters, the client has a history of self-harm. Morris, an ACA member who specializes in working with teens and adults struggling with anxiety, depression, behavioral issues and life transitions, is working to cultivate the client’s inner strengths to help her through this challenging time. For example, because the client is artistic, Morris has encouraged her to use expressive coping techniques. So, when the client feels the urge to harm herself, she opts to paint that part of her body instead.

Morris, owner of the private practice Reimagine Life Counseling Services, thinks these types of relationship issues are likely to increase. Once pandemic-related restrictions are lifted, some people will be anxious to leave home or to be apart from certain family members, whereas others will start dealing with the outcome of being stuck in a toxic environment for months on end, she says.

Soderstrom believes counselors may see an increase in clients who are panicked about leaving home and being away from family members because they have grown more attached during the pandemic. “It’s like a part of who we are didn’t get exercised [during the pandemic] and got out of shape,” he says. “We have to exercise that part of ourselves again to be our full selves. … We have to reexperience fear. We have to reexperience doubt. We have to reexperience … emotional isolation outside the house.”

Soderstrom knows how much isolation can affect someone’s social anxiety. A few years ago, he had an extroverted client who lived overseas with his father for an extended period of time. The client mostly stayed isolated inside his apartment because he didn’t speak the local language. When he returned to the United States, he came to see Soderstrom because he had developed social anxiety about reconnecting with his friends. The extended break from his social activities had affected his self-confidence, and he found it easier to avoid his friends, which only reinforced his anxiety, Soderstrom says.

With Soderstrom’s help, this client overcame his anxiety, but Soderstrom worries that once the need for physical distancing finally passes, more people will struggle with social anxiety and panic disorders because they too have been isolated for extended periods of time. He predicts that some people will find social situations such as going to the mall or being around large groups of people triggering at first.

“Because this [pandemic] is such an individual experience for everybody, people are going to come out of this or move forward from this with different [experiences], such as losing somebody or experiencing trauma in the home,” Morris observes. These differences will affect how people learn to interact with one another again, she adds. 

Confronting, not avoiding, anxiety

Clients often come to see Andrea Batton, a licensed clinical professional counselor and the clinical director at Maryland Anxiety Center, and ask her to “get rid of their anxiety.” No one wants to feel anxious or afraid all the time, of course, but the treatment goal isn’t to completely eradicate these feelings, she says. Batton, an ACA member who specializes in treating anxiety and OCD-related disorders, explains to clients the adaptive nature of these emotions, which includes informing us about our environment and helping us to survive. The point of counseling is to learn how to respond to these emotions in more helpful ways, she says.

Similarly, Soderstrom advises his clients not to ignore these thoughts and feelings but rather to be curious about them. Too often, he says, clients try to run away from these thoughts. “We try to control thoughts by either getting rid of the trigger or avoiding the trigger,” he explains. His goal is to get clients to embrace their emotions by capturing the thought and refocusing their energy back into their body or on another thought they value more.

So, if an adult child is eating lunch with their father and they have an irrational fear that they have the COVID-19 virus and just gave it to their father by hugging him, they can pause and acknowledge this intrusive thought as one that may feel true but isn’t. They can ground themselves by shrugging their shoulders, remind themselves of the low likelihood they are giving their father the virus, and refocus their attention on what they will discuss during lunch.

“The art of refocusing gives us ultimate power,” Soderstrom says. “It’s the moving on or refocusing on something we value or something that’s important that teaches us to devalue whatever the [intrusive] thought was rather than avoiding it.”

Although this isn’t the intent, physical distancing guidelines are encouraging many people to avoid the stimuli that trigger their anxieties or fears, and this can have serious repercussions on their overall progress, says Batton, a member of the International OCD Foundation and a board member for OCD Mid-Atlantic. Some school-age children, for example, struggled to go to school before the pandemic because they wanted to avoid situations that might trigger worries about having a panic attack or a specific phobia such as a fear of vomiting. Virtual classes — which have become common during the pandemic — serve to reinforce avoidant behavior.

“Avoidance is a compulsive behavior that reinforces the notion that there is danger at school,” Batton says. So, she wants to see these students return to in-person instruction full time. The same goes for clients who want to avoid work or other settings that trigger anxiety, phobias, or OCD-related worries or fears.

Counselors will have to work with their clients to figure out plans to ease them back into these spaces once it has been deemed safe to do so, Batton continues. “We don’t want anxieties, worries and fears to limit your life,” she says. “We want you living in accordance with your values [and] life goals, not [with] what anxiety tells you to do or your fears tell you not to do.”

Reappraising negative thoughts

When people are triggered, their mind automatically goes to worst-case scenarios, says Batton, a member of the Anxiety and Depression Association of America. When clients struggle with worst-case-scenario or all-or-nothing thinking, also known as “thinking traps,” counselors can help by teaching them how to respond to their thoughts more rationally, she continues.

Cognitive reappraisal isn’t about “looking on the bright side” or trying to be positive, Batton notes. Instead, counselors should help clients consider other possible explanations and look at what else might be going on. For example, if a student is struggling in a virtual class, they may start to think, “I’m going to fail the class. Everyone else understands the material. I’m stupid.” These thoughts will only make the student feel more anxious about the class, so they will dread doing homework or even avoid going to the class again, thereby reinforcing these less rational thoughts, she explains.

Batton’s goal instead is to teach the student to take a step back and consider what else could be true about the situation. Maybe the other students are also confused. Maybe the class is difficult. Maybe the student won’t get an A in the class, but they will still pass. After challenging the negative belief, the student can engage in more adaptive and helpful behaviors such as starting a study group or speaking with the teacher about how to improve in the class.

This cognitive reappraisal technique helps clients change the way they respond to intrusive thoughts over time. “When you’re having more rational thoughts, you’re going to feel more neutral. You’re not going to feel as anxious. You’re not going to feel discouraged … or afraid,” Batton explains. These neutral emotions and rational thoughts lead to more productive behaviors, which in turn fuel more rational thoughts. 

Morris says many of her clients are falling into thinking traps when it comes to the pandemic. She often relies on thought-stopping exercises to help them get unstuck and move forward. If a client is afraid to leave their house because they may get the COVID-19 virus, she helps them identify the trigger and stop the negative thought before it snowballs into a physical reaction. She asks the client, “What is one small thing you can do to feel more in control?” Maybe they could put on a mask and go for a careful walk around their neighborhood rather than locking themselves inside their house.

Morris also shows clients a few common thinking errors such as negative labeling (e.g., “I’m stupid.”), blowing things up (e.g., “This pandemic will never end. I’m going to live alone forever.”) and self-blaming (e.g., “My neighbor has COVID-19. I probably gave it to them.”). She then asks them to identify which ones they are experiencing. This helps initiate the conversation and individualize the coping skills the client needs to respond to these thoughts, she adds.

Soderstrom helps his clients engage in logical, rather than emotional, thinking by asking Socratic questions. For a client who worries that they didn’t clean the doorknob well enough and may be responsible for giving their family the COVID-19 virus, Soderstrom would simply ask, “Would you bet $10,000 that if a scientist came and swabbed the doorknob, they would find the virus? What’s the evidence for this thought? What would you tell your friend if they were in a similar situation?”

He also asks clients to complete a thought record that consists of seven columns: the situation/trigger, feelings, unhelpful thoughts/images, facts that support this thought, facts that challenge this thought, an alternative (more balanced) perspective and the outcome. This activity anchors clients and pulls them away from black-and-white thinking, he says.

Rethinking exposure therapy

As Batton points out, exposure therapy is the backbone of clinical treatment for anxiety and obsessive-compulsive and related disorders. But not all exposures are possible during a pandemic. Asking a client with social anxiety to go to a large party is bad therapy right now, Batton jokes.

For that reason, counselors have to get creative with their exposure ideas. For example, Batton is using a HIPAA-compliant version of Zoom and Bluetooth to “ride along” with her clients who have driving phobias. This allows her to still see clients’ facial expressions, such as a clenched jaw, while she coaches them during the exposure. When she has a client with compulsive bathroom rituals, she sets a timer and virtually watches them brush their teeth to limit how long they engage in this behavior. Batton also helps clients with emetophobia (a fear of vomiting) by making fake vomiting noises together during the virtual session, sharing her screen to look at photos of vomit and watching video clips of other people vomiting.

Regardless of how the exposure occurs, the goal is to initiate those intrusive thoughts and anxieties to help clients realize that their worst fear is unlikely to occur. Through this experience, they don’t “unlearn” the fear. Instead, they gain “new safety learning” or inhibitory learning (i.e., learning that the feared stimuli and their emotional response to it are safe) and habituate to the thoughts and uncomfortable feelings, Batton explains. The fearful thoughts lose their power and diminish over time, she adds.

Before the pandemic, Soderstrom rarely went into clients’ homes to do exposure therapy. Now, with the transition to telebehavioral health spurred by the pandemic, he regularly enters clients’ homes virtually and works on their phobias and anxieties in real time. For example, one client fears losing control and accidentally stabbing her grandmother. Previously, as part of treatment, he would ask the client to take a plastic knife and sit beside her grandmother or hug her as a homework assignment. Now, he can observe her while she actually performs this exposure exercise.

Soderstrom is also finding inventive ways to help clients focus on their core fears. For example, he’s asked clients with social anxiety to call someone on the phone and post new videos on TikTok.

Virtual exposures have actually expanded Soderstrom’s options for treatments because, as he points out, “so many obsessions/compulsions are done inside the house.” So, he plans to continue virtual exposure sessions even after he returns to having in-person sessions. He likes that the virtual exposure sessions provide him with visual, not just written, evidence of clients’ progress.

Batton finds that virtual exposures have provided cost-effective treatment options for her clients. Before the pandemic, she had to charge a travel fee every time that she conducted an in-home visit to do exposure work. Because of the pandemic, and thanks to telebehavioral health, in-home visits have been eliminated, and because exposure therapy is typically as effective virtually as it is in person, she plans to continue this practice on occasion after the pandemic-related restrictions end.

Counselors’ own fears (and hopes)

At the beginning of the pandemic, Soderstrom worried he would lose his connection with his clients. He thought he wouldn’t be as effective as a therapist because of the physical distancing restrictions. But Soderstrom was happy to learn his fears were unsubstantiated. He just had to adjust his technique and become more vulnerable with his clients.

With telebehavioral health, clients may not be able to pick up on the counselor’s body language, or they may not feel comfortable being vulnerable themselves, Soderstrom says. He finds that being open and honest about the way he is feeling often elicits clients to be more open with him. For example, he recently told a client, “Sometimes, I feel like it’s hard to do treatment right now.” This prompted the client to share that they also found therapy difficult. The client hadn’t been able to finish their therapeutic homework assignments that week and had even considered quitting therapy. Soderstrom reassured the client that they weren’t alone in this feeling. 

Morris believes that counselors need to keep suicidality on their radars in the coming months and years. The suicide rate among teenagers has already been rising, and one must assume that the job losses, isolation and loss of life resulting from the coronavirus pandemic will only push that rate even higher, along with suicidal ideation among both teenagers and adults, she says.

Morris emphasizes the importance of counselors doing more outreach during these times. She recently hosted a webinar for a local high school on how COVID-19 is affecting teenagers and discussed the warning signs of suicide as a preventive measure. By providing psychoeducation, she hopes to normalize conversations about suicidal ideation and prevent future suicides.

Batton’s biggest fear for the profession itself is that many counselors will choose to engage with clients exclusively through telebehavioral health even after the pandemic danger has passed. She acknowledges that returning to in-person sessions may not be easy or straightforward for many clinicians, especially if they had to break the lease on their office spaces. But she hopes most counselors will find a way to return to an office in some capacity. Batton longs to see clients and counselors interacting in person again, in part because in-person sessions are beneficial for clients who struggle with certain fears and anxieties such as social phobias, she says. 

Morris shares Batton’s concerns about the possibility of counselors not returning to their offices. She’s currently hiring counselors for her clinical office and has found many of them are still fearful of providing in-person sessions, even after taking the appropriate precautions of wearing masks and sanitizing between sessions. Morris acknowledges that the whole process has been unsettling for many clinicians. First, they had to quickly adapt to moving their practices online; now they are being told they can go back into the office with safety precautions. She wonders, “How long is it going to be before counselors feel comfortable again with face-to-face sessions?”

Soderstrom says some of his clients are worried about the potential consequences of the prolonged suffering experienced over the past year because of the pandemic. Others with anxiety disorders and OCD fear that if their situation gets too tough, they might implode or incapacitate themselves with worry. He reassures them that humans are strong and can adjust to even the worst circumstances — just as they have done before.

 

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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.

Fear and anxiety at the ballot box

By Laurie Meyers October 22, 2020

Word began to filter out late morning on Tuesday, Oct. 13, the last day that Virginia residents could register to vote in the 2020 general elections. A severed fiber-optic cable had brought down the commonwealth’s voter registration portal. Officials said the cut was an accident caused by roadwork; skeptics on Twitter had “accidentally” trending. Paper registration was still available — if postmarked or dropped off at local voter registration offices.

By midafternoon, after an approximately six-hour outage, the site was back up. A federal judge ordered an extension of the deadline to compensate would-be voters for lost time. Everyone would still be able to register to vote. All’s well that ends well, right?

And yet. To many people, the snafu seemed like just one more alarming plot twist in the tale of an election season — and year — so fraught with unprecedented crises that it would most likely evoke reader skepticism if found within the pages of a novel.

The U.S. national elections are already set to serve as a proxy for the country’s stance on climate change, universal health care, racism, police brutality and (dueling visions of) democracy. The maelstrom of events that is 2020 has brought everything to the forefront in Technicolor. The death of George Floyd under the knee of a police officer. The ensuing protests against police brutality and the continuing demands for an end to racial injustice. The spread of violence by white supremacist groups. Record-breaking wildfires in California and Oregon. An incredibly active — and ongoing — hurricane season. The death of Supreme Court Justice Ruth Bader Ginsburg and the rush to appoint her successor. All of it amidst a pandemic unlike any other seen in the past 102 years.

When most Americans started staying home in March in hopes of bringing down the levels of infection by the novel coronavirus, they most likely didn’t expect that almost everything about COVID-19 would become partisan. The degree of threat posed by the virus. Whether to close businesses and restrict community movement. To mask or not to mask? In some quarters — albeit fairly fringe ones — the very existence of the novel coronavirus became a partisan matter. Now, less than one month before the election, more than 225,000 Americans are dead — a total that includes a disproportionate number of Black, Indigenous and people of color — and voters have spent months wondering about the best way to cast their vote.

In response to voter anxiety about going to the polls in person, most states expanded absentee mail-in voting by allowing anyone to use COVID-19 to justify their request. But the U.S. Postal Service, which had been preparing for the surge, was subject to organizational and equipment changes that made the mail less timely. So, many voters worried: If they requested an absentee ballot, would it arrive in time? The requirements for mail-in ballots vary from state to state, leaving some voters baffled and bemused. A process that is usually fairly straightforward has become yet another tangle to unravel in a year that has been fraught with knots.

“Our ability to cope with uncertainty is maxed out,” says licensed professional counselor (LPC) Keri Riggs, an American Counseling Association member with a private practice in Richardson, Texas. The pandemic has also effectively put most of our previously established timelines in question.

“We can’t make plans,” Riggs, whose areas of specialization include depression and anxiety, says. “The thing about the election is that we have a theoretical deadline.” We’ve always thought we understood when voting for the election was over, but this year, we can’t even have a sense of certainty about when it might end and when an undisputed winner in the presidential election might be declared, she says. Part of this year’s election anxiety is tied to not being able to rely on that usual deadline as an endpoint to at least one source of uncertainty.

With the exception of the contested vote count in Bush vs. Gore in 2000, modern Americans are used to learning who the winner of the presidential election is on election night or the morning after. But because so many people are voting by mail this year and it will take time to process those ballots, the votes amassed on Election Day will not be the final tally.

“If there is a contested election, it could drag on for a very long time,” Riggs points out. “Everything has already been dragging on for a very long time.”

And it’s not just about the endpoint. Many voters see this election as more than a mere partisan contest; to these voters, it is something upon which the future of bigger picture issues such as climate change, immigration and racial justice rests. In fact, a recent Pew Research Center survey found that 83% of registered voters say it really matters who wins the presidency. These results are an increase from the 74% of voters who said the same thing four years ago and the highest share of voters saying this in two decades of Pew Research Center surveys. In keeping with the anxiety surrounding the election, approximately 50% of survey respondents said they expected that voting will be difficult.

The stories that we tell ourselves play a critical role in how we cope with stress, anxiety and the seeming chaos around us, Riggs says. Too often, clients focus on the “what ifs” of a doomsday future that may or may not come to pass, she explains.

“The Islamic theologian, Sufi mystic and poet Rumi once said, ‘The words you speak become the house you live in,’’’ notes Ryan Thomas Neace, an LPC who is the founder and CEO of Change Inc., a St. Louis counseling practice that focuses on healing and personal growth in the face of pain. A similar dictum is contained in the Hebrew Scriptures, “The power of life and death is on the tongue,” he continues. “In other words, what we say matters.”

Neace is not denying that voters are facing weighty issues as they cast their ballots, but he maintains that the narratives we construct are not solving anything. Instead, people get caught in the trap of thinking that constant worry and panic are somehow equal to civic engagement or political purpose.

Clients can break their “doom” loops with present-moment awareness, Riggs says. For example, when fear of the future and visions of disaster threaten to take over, she has clients practice telling themselves that they and everyone they love are safe in that moment.

Riggs also advises clients to consume social media and news in moderation and to take breaks. She urges clients to channel their energy into productive action, either by engaging in the political process with a campaign donation or volunteering at the polls, or via a smaller personal outlet such as journaling or even cleaning the bathroom.

Riggs says it is also essential to exercise self-compassion and what one of her clients calls “grace.”

“We need to give ourselves and each other grace — the benefit of the doubt,” she says. “We’re not all on our A-game.”

Neace reminds clients that it is OK — indeed helpful — to tell themselves resilience-building stories such as, “There’s a lot at stake here, but we’re going to get through this together, no matter what.”

President Donald Trump and former Vice President Joe Biden, pictured in a nationally-televised debate on Sept. 29.

Fear of racial violence

“There is a lot of evidence that there are a number of groups that actively want to hurt and disenfranchise Black Americans,” says Harrison Davis, an LPC in Atlanta who specializes in depression, anxiety, resentment and helping people overcome personal obstacles. These groups have come out of the shadows and appear to feel empowered by what they — and many Black Americans — perceive as support from the police and from forces within certain parts of the government and judicial system, he says.

The clients and community members he’s spoken to say their sense of security has diminished over the past year because they feel betrayed by people they believed were their allies. Some of his Black clients have told Davis that instead of standing by them in the fight for racial justice and an end to police brutality, some of their white neighbors and friends supported these law enforcement actions and were actively critical of the ensuing protests.

On top of this vulnerability, some of his Black clients have expressed concern that President Trump has not committed to a smooth transition of power if he loses, while white supremacists are threatening violence or even war, Davis says.

Some clients have an almost panicky need to prepare for an emergency — as if by doing so they can keep their darker fears from manifesting, he continues. This sense of catastrophe is fueled not just by the election, but by the many deaths the coronavirus has brought to the Black community.

Although the threat is real, his clients’ response — living in a constant state of anxiety and panic — is neither healthy nor sustainable, Davis says.

Like Riggs and Neace, when working with clients struggling with election anxiety, Davis zeroes on how much news and social media they are consuming. Not only are clients being bombarded with a sense of overall catastrophe—they are engaging in conversations that are often vitriolic and damaging.

“When I grew up, you would just watch the polictical coverage on the TV networks,” he says. Now, everyone can watch a developing story or scandal in real time. So Davis asks clients to notice how they are responding as they track this torrent of information. “Is it causing you to tense up?” he asks. “Lose sleep?” Clients also report irritability and constant worry–not just about the election, but everything. Right now, the constant urgency and concern of news and social media has such a marked effect on clients, that Davis has moved away from recommending that they balance their use. Instead, he has them do a complete detox.

“Channel that energy into positives instead of arguing with people,” he urges clients. Rather than trying to convince others of their viewpoint, they could be helping people register to vote or get to the polls on Election Day. Davis also encourages clients to find hobbies and outlets that have nothing to do with politics or current events.

On a deeper level, he finds that clients are struggling to accept the world as it is. They may have believed that we had grown as a nation and society over the past decade but now may see that things haven’t changed significantly. One way to cope with that reality and find greater peace is to identify ways to help the community, Davis says.

In his own life, Davis’ father, who was an activist in the civil rights era, told him and his siblings that they might have thought things had changed, but they really hadn’t. Black Americans are still engaged in the struggle for racial equality that has been denied them for generations.

That doesn’t mean that clients need to live in fear, Davis says. Living like that only gives power to those who want Black people to be afraid. He urges clients to find a space where they feel like they belong and to be thoughtful about who they invite into their inner world. They may not yet be able to change the world, but they can control elements of their world by removing unsupportive friends or by leaving environments which make them feel triggered or unsafe—such as social groups or toxic work environments.

A number of his clients are very spiritual, Davis adds. They find strength through the Bible, which holds many stories of people who experienced tragedy and injustice but prevailed by relying on faith and their community.

Power and connection amid chaos

Although many of us view the cacophony of the election cycle as something to endure while keeping our sanity in check, ACA member Laura Brackett is encouraging clients to find their personal power in the chaos.

The year 2020 and the years leading up to it have been traumatic in myriad ways, and exploring personal power is a constant component of trauma work, she says. “The beauty of it is that personal power takes countless forms,” says Brackett, the director of community engagement at Change, Inc., in St. Louis. “For some clients, this has meant outward action in the form of voting, protesting and becoming active in the community. For others, it has meant embracing their own emotional reactions and how that is influencing their behavior and empathy toward self and others.”

Often the process involves a combination of both external and internal work, she says. Brackett’s goal is to encourage clients to embrace their personal power without losing sight of how its expression affects others.

“If there is one thing this year has shown us, it’s that we don’t live in a vacuum,” she says. “Our words and actions have real impact on others. I want to help my clients see this interconnectedness and learn how they can best live within it in a way that is compassionate as well as empowered.”

 

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Related reading, from ACA’s Department of Government Affairs and Public Policy: “Counselors Are Voting in 2020

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Laurie Meyers is a senior writer for Counseling Today. Contact her at lmeyers@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.