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Humanistic Counseling

Using existential-humanistic psychotherapy in the treatment of COVID-19 survivors

By Audrey Karabiyik September 22, 2020

To say 2020 has been an unusual year would be quite an understatement. As a collective human society, we have all experienced significant alterations to our once normal lives. One factor, COVID-19, has played the predominant role in this process, and some individuals have been affected more than others.

My personal experience with COVID-19 has prompted me to write this article so that my fellow counselors will have guidelines for helping other COVID-19 survivors. It is important to note that no evidence-based therapy practices are currently available as the pandemic continues to unfold. Before this, we had not experienced a worldwide pandemic in 100 years.

What is existential-humanistic psychotherapy?

Existential-humanistic psychotherapy helps clients discover their own uniqueness through acquiring a greater awareness of themselves and the world around them. The therapist assists clients by teaching them to see their resistance so that they can have a more meaningful existence. Clients are free to explore which aspects of their lives support their journey and which can be discarded to live a fuller existence. This approach avoids labeling and diagnosing, so the focus can be placed on self-searching and meaning.

There are five key goals in existential-humanistic psychotherapy.

  • Develop the capacity for self-awareness and understanding the ramifications of freedom of choice
  • Create a personal identity and be present for quality relationships
  • Search for the meaning, purpose, values and beliefs of life
  • Accept normal anxiety as a natural condition of living
  • Become aware of death and nonexistence

Where to begin

The COVID-19 symptomology and experience are unique to each individual, so it is important for existential-humanistic psychotherapists to encompass a number of traits.

The therapeutic alliance must be established during the initial visit. First, by adopting an I-Thou relationship with the client, you establish a relationship in which the client is the authority of their personal illness experience and life. Second, by providing unconditional positive regard, your acceptance and support will allow the client the important opportunity to share their subjective experience and reflect upon it. Third, by utilizing empathy, you will permit your client the freedom to share a fuller range of feelings and emotions with you, thus creating a space to deepen their authenticity.

Stages for COVID-19 exploration

Stage One: Life before COVID-19. This is an excellent entry point to begin the I-Thou therapy relationship. The client will start to gain an understanding of your existential-humanistic style.

Simultaneously, you have the important opportunity to explore your client’s communication style and level of expressiveness. You will acquire an understanding of your client’s typical lifestyle, level of functioning, and what values and beliefs existed for them prior to the COVID-19 pandemic. Additionally, you can establish the client’s goals and what they wish to achieve during therapy.

Questions that may be of help could include:

  • Who were you living with?
  • What was your typical day?
  • Were you actively employed? How important was your job to you?
  • How did you spend your free time?
  • How was your general health?
  • Did you take time for yourself?
  • What was your “normal”?
  • What did you value most at that time?

My normal was living with my husband and son. My husband had endured six months of cancer treatments in another country the year before, and we were finally able to live together again. I was working in a counseling capacity. Our spare time was usually spent being with family and friends, traveling and enjoying our personal hobbies. 

Stage Two: Understanding the client’s early illness. In this stage, each client recalls and shares their unique symptomology and experience. At this point, your client may have greater comfort in the therapeutic relationship as a result of you engaging in active listening and empathetic techniques. You teach the client to explore their problem to develop insight by sharing physiological and psychological feelings related to their early illness.

Questions that may be of help could include:

  • How did the disease manifest itself?
  • What were your early symptoms?
  • Where do you think you came into contact with the disease?
  • When did you realize you were seriously ill?
  • What action did you take to address your illness?
  • What were you thinking and feeling about your symptoms?
  • What were your concerns at that time?

My symptoms — dizziness, cough, a heightened sense of smell, kidney pain and extreme fatigue — started in late March. My doctor prescribed an antibiotic and suggested I avoid the emergency room because it was believed that all in-house patients were positive for COVID-19 at that time, and if I did not have COVID-19, I would surely acquire it when I arrived. (It was days later that I understood her logic).

So, I spent a few days in bed, sleeping most of the time. I made every attempt to avoid the kitchen because the cooking odors were overwhelming to me. I had a desire to indulge in very hot baths, but each one seemed to make me weaker than the one before. I was feeling unsettled at this point because of the inconvenience of missing work. I also had feelings of fear that things would worsen. 

Stage Three: Determining the client’s level of illness. This stage involves the realization of a more serious illness, worsening symptoms and the eventual need for a higher level of care. Ideally, your client will be able to express a broadening range of feelings and thoughts as they reveal how they came to terms with their level of illness. As the therapist, you can begin to introduce the concept of freedom of choice in their decision-making.

Questions that may be of help could include:

  • How long had you been sick by this point?
  • What were your worsening symptoms at this time?
  • What made you decide to seek additional care?
  • How did you discover that you actually had COVID-19?
  • How long were you in the hospital?
  • What were you thinking and feeling when you realized what was happening?
  • What were your concerns at that time?

As part of four days of deepening symptoms, I had ceased all eating and drinking. I was unable to consume anything, mostly due to my heightened olfactory symptoms. Simultaneously, I was beginning an insidious decline in my ability to oxygenate my lungs, so I finally had my husband take me for the inevitable drive to the emergency room.

We were met outside the hospital by a front-line health care worker in complete personal protective equipment. My husband was required to leave before I was permitted to enter the emergency room. In these early days of the pandemic, with only a limited number of cases being discussed in the media, the seriousness of the disease was not yet widely known, but the possibility existed that I might never see my husband again. Although we had both experienced the fear and sadness of my husband leaving for cancer testing and eventual diagnosis the prior year, I believe we both inherently knew that my departure was unlike anything we had encountered before.

Stage Four: What were the client’s experiences during their care? While this stage addresses what was happening physiologically with the client, it is also giving birth to several key existential concepts for early exploration. As COVID-19 patients spend time in the required isolative ICU, anxiety rises and universal themes such as freedom of choice, isolation, meaningless and death are thrust upon them, becoming inescapable.

First is exploring the meaning of illness itself while having to grapple with giving up control. Second is finding meaning in the aloneness they are experiencing. Some clients may find that this is the first time in their life they have ever been alone or had an opportunity to focus solely on themselves. Third is finding meaning in the emptiness of their surroundings. Fourth is dealing with finding meaning in life itself and coming to terms with potential death.

You (as the therapist) can openly discuss the reality of death at this stage. Active listening and unconditional positive regard are of the utmost importance during this stage because this is where the transformation ultimately begins. The client deserves to have the complete freedom to share all of their thoughts, memories and feelings, no matter how irrational they may seem to you.

Questions that may be of help could include:

  • Did you understand what was happening medically?
  • What were your emotions during early care?
  • Was this your first experience with emergency care?
  • How did you feel when you realized that you had to give up full control to the medical staff?
  • What treatments did you receive?
  • Did you require the use of a ventilator?
  • What was your length of stay?
  • What emotions and feelings came into play? Were you frightened? Bored?
  • How did you feel being all alone?
  • What were you thinking and feeling when you realized what was happening?
  • What were your concerns at that time?
  • Did you think you were going to die?
  • How did you deal with that thought?
  • Did you draw any conclusions?

During my first career, I spent many years as a front-line health care worker. Therefore, in the hospital setting, I was returning to my roots and was fully aware of what was happening. With that said, too much knowledge can also prove frightening. I was quickly made aware of the gravity of the situation, and I was well aware that the best approach was to instantly give up control so the staff could make every effort to save my life.

I spent the next two weeks in ICU, continuously receiving 15 different medications, mostly intravenously, and 24-hour-a-day oxygen therapy, as well as undergoing many venous blood and several arterial gas tests and portable chest X-rays. My oxygen levels were very low and not responding to treatment.

The realization had long since set in for me that I would not have visitors and that death was a possibility. My entire focus went to one thing: continuing to inhale and exhale repeatedly, even as COVID-19 played tricks to convince me to stop breathing. A ventilator was considered, but I knew there would be an 85% chance of never breathing on my own again. Each labored breath represented many things — avoiding the ventilator, returning to the presence of my husband and son, lying in my own comfortable bed, not dying alone.

Despite my desires to return home, I spent many hours in the ICU contemplating the life I had lived and the possibility of death. I reconciled my life with God and was in a place of total peace. I came to terms with all of the relationships in my life, feeling sorry for those individuals incapable of making true connection. I was filled with extreme gratitude for what I had been provided throughout my life, including family, special friendships and the ability to connect with others.  

Stage Five: Post-hospital healing and meaning. Checking out of the hospital left me with immense hope. I had achieved what I had set out to do there. At this point, I was still on oxygen 24 hours a day and was able to walk about 24 feet before exhaustion set it. Because little information was available, the doctors required me to quarantine alone for another week, then another. I came to the realization that all one can do for the sick or terminally ill is to provide sustenance and let the person know they are loved.

Two weeks alone in my bedroom and my perspective had changed again. My wonderful bed had become my new prison. But, finally, I was set free of isolation and able to experience smiles, laughter, human touch, hugs and togetherness again.

Stage six: Where do we go from here? Certain clients will benefit from cognitive behavior therapy at this point to explore any distortions that may exist and will become content with their progress, thus ending their therapy at this time.

Others, having been given the opportunity to unleash their personal COVID-19 journey, will begin to open to possibilities for the future. First, you can explore anxiety with the client. You can provide psychoeducation to help the client understand the purpose of anxiety and to distinguish between existential, normal and neurotic anxiety. You can then explore how freedom of choice is used in decision-making and relates to the future and discuss the reality of death in greater detail. Introduction of Maslow’s hierarchy and self-actualization can provide the client psychoeducation to increase their self-awareness in the present and give them a road map for the future.

Questions for possible exploration can include the following:

  • Do you see yourself differently since your illness?
  • What things did you learn about yourself?
  • Are you more comfortable with yourself at this time?
  • Have your values or beliefs changed in any way?
  • Have your thoughts or fears changed related to death?
  • Are there any changes you would like to make in your life?
  • How would you like to spend your time in the future?
  • Will you handle situations differently?

Lingering COVID-19 symptoms, including bouts of low energy, occasional low oxygens levels and the unfortunate loss of a great deal of hair, still plague me. However, they are insignificant compared with my desire to help recovering COVID-19 survivors and front-line workers find meaning in their personal experiences.



I would like to thank Ayala Winer and Arlene Gordon for their gentle guidance in encouraging me to share my story.



Audrey Karabiyik is a graduate of Nova Southeastern University and is currently a registered mental health counselor intern in Florida. She is starting several COVID-19 groups geared toward survivors, front-line workers and others wishing to process the “new normal.” She is associated with Systemic Solutions Counseling Center in Plantation, Florida. Contact her at AudreyKarabiyik@gmail.com.


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

Where East meets West

Lynne Shallcross October 1, 2012

Cliff Hamrick was meditating long before he became a counselor, having found the practice useful for treating the depression he had experienced some years before. Now a private practitioner in Austin, Texas, Hamrick integrates Eastern and Western approaches to counseling because he believes it benefits his clients.

Partway across the country in Connecticut, counselor Deb Del Vecchio-Scully also combines Eastern and Western approaches when working with clients. She discovered guided imagery and meditation almost three decades ago while seeking ways to manage her pain after multiple back surgeries.

As technology continues to “shrink” the world and as the counseling profession steadily expands its global presence, it is not hard to predict that an increasing number of counselors will join Hamrick and Del Vecchio-Scully in further breaking down barriers and intermingling Eastern and Western approaches to counseling.

Isabel Thompson, an assistant professor with the Center for Psychological Studies at Nova Southeastern University, has researched and presented on this topic. She has also integrated Eastern contemplative approaches into her work with clients and says Eastern and Western counseling approaches have similarities in that they both focus on relieving human suffering and helping people feel better. But they also differ, she points out. Generally, Western approaches place more focus on psychopathology and rely on a medical model of alleviating symptoms, Thompson says. Although Eastern approaches can also be applied to psychopathology and the alleviation of symptoms, their primary focus tends to be on flourishing and achieving optimal human development through leading an ethical life, says Thompson, a member of the American Counseling Association.

Fred Hanna, a professor in the Department of Counselor Education at the University of Northern Colorado, says Western approaches place more emphasis on correction and on mitigating feelings and symptoms. Eastern approaches, on the other hand, are more aimed at liberation and “setting [people] truly free so they can be in charge of their feeling states and so they can control their thoughts,” Hanna says. “This can be done through Eastern meditation techniques as well as direct Eastern-derived psychological techniques.”

In traditional Western thought, emotional problems aren’t viewed as affecting the body, Del Vecchio-Scully says, whereas in traditional Eastern thought, it is all interactive. “Everything that happens in the body affects the mind and emotions, and vice versa,” says Del Vecchio-Scully, a certified yoga therapist and Reiki master who is also the executive director of the Connecticut Counseling Association, a branch of ACA. Del Vecchio-Scully often sees that mind-body interaction play out among her clients, who are referred to her through the neurology group for which she works, Associated Neurologists of Southern Connecticut.

“I find that Eastern thought is rooted more in the integration of mind-body and energy,” says Serena Wadhwa, an ACA member who works in a hospital outpatient group practice and runs a private practice in Chicago. “Western thought tends to separate body and mind, although there is much progress [being made] in this area. We see the approaches of yoga, tai chi, Ayurveda and Chinese medicine, to name a few, that also focus on utilizing the body’s natural healing systems and restoring balance. Western thought usually involves a ‘quick fix’ medicinal approach.”

In a broad sense, there’s also a difference in the locus of control, says Hamrick, a member of ACA. With many Eastern approaches, it is assumed that people will fix themselves, often by paying close attention to themselves and their surroundings, he says. In the West, that control tends to be externally located, he says, with the expectation being that the “right” technique or intervention will fix the client. Hamrick says those differing ideas likely took root in the respective cultures. Buddhist and Hindu traditions teach that each individual person has a soul or god residing within them, whereas Western European thought suggests that individuals should rely on an external, all-knowing God or someone else to help them and guide them along the way. In the West, that often translates to the counselor being viewed as the “expert” and outcome success hinging on the counselor’s advice and interventions,
he says.

Hamrick believes there is room for both views. He likes for his clients to feel that they possess the power within to handle and solve their mental and emotional issues, which is based more in Eastern thought. But on the Western side, he says, an abundance of good scholarly work is being done that he can pass along as knowledge to his clients, such as new research in neuroscience and positive psychology.

Although Eastern and Western counseling techniques traditionally come from different vantage points, Wadhwa says it is important for counselors to recognize that the underlying concepts are often the same. For example, the idea that our thoughts have an impact on us is fairly universal, says Wadhwa, who is originally from India and has presented on Eastern treatment considerations in working with Asian populations. “So I use both cognitive restructuring and mindfulness in my work, and depending on how I introduce these techniques, the individual I am working with may be more open to exploring how it may work for them.”

Wadhwa says she discusses with clients how thoughts may cause suffering and explains the idea behind both approaches. “I explain how cognitive restructuring works by providing strategies to cope with the thoughts and how mindfulness practice works at detaching from the thoughts and focusing back on the present moment. I also explore how coping with the thoughts may be initially more relieving than mindfulness, as mindfulness takes practice. Most clients are open to learning how to cope with their thoughts and then how to detach from them.”

Taking control

In a counseling session that he supervised, Hanna remembers a client diagnosed with borderline personality disorder who had cut herself habitually and reported that she had attempted suicide 160 times. Hanna and his doctoral student asked the client to bring to mind the feeling she would have just before she started to cut or attempt suicide. “Then what we did was have her go directly into that feeling,” says Hanna, a member of ACA. “It was sort of a therapy-assisted meditation of exploring those feelings.”

Hanna and the counselor-in-training asked the client to imagine she was in an elevator made of thick, clear glass that she could take straight down into her feelings. They told her she couldn’t feel the pain or anxiety inside the elevator but that she could see what was deep down inside those feelings. In her mind, the client took the elevator, little by little, all the way to the bottom. She reported that it was like a lake, and at the bottom of it all, there was really nothing to be afraid of. After reaching the bottom and thoroughly exploring her feelings, the client filled the lake with earth and put a house on top of it in her mind. “After those sessions, the client reported a marked decrease in her borderline symptoms,” Hanna says.

Hanna created the approach that he and his doctoral student used with the client. He calls the approach “internal control therapy,” which he describes as a blend of yoga psychology, Buddhism and a few Taoist ideas. “Using that object-oriented approach, [the client] was literally taking control over those feelings … that were before in control of her,” Hanna says. Internal control therapy makes use of a client’s powers of creativity to generate positive feeling states and unbuild negative ones, he says.

From a yoga psychology perspective, the mind is an object that can be manipulated, akin to an ordinary physical object, Hanna says. His internal control therapy taps into that perspective. “If [clients have] a strong image in their mind of someone who hurt them and they carry that image around — I wouldn’t want their image hanging in my living room, would I? But we carry those images around in our minds. … If you treat [that image] as an object, you take it down and throw it away.”

Although yoga psychology is a traditionally Eastern approach, Hanna thinks its application can benefit Western psychology by offering an alternate view of psychopathology. Whereas the Diagnostic and Statistical Manual of Mental Disorders (DSM) presents classifications for disorders in an attempt to explain and treat mental illness, Hanna says yoga psychology offers the idea that there are five points that lead to suffering and dissatisfaction with life: ego and self-centeredness; cravings beyond what we need; resisting something; ignorance; and fear of death. In this view, when people get overly bogged down with any of the five points, it can result in suffering and psychological problems.

Hamrick gravitates toward a different Eastern-based approach — mindfulness meditation — introducing it to almost every client with whom he works. “Usually in the first session, I will spend about five minutes walking a new client through a sitting meditation just to show them how the technique works and demonstrate its usefulness,” he says. “My clients with anger, depression and anxiety find it particularly helpful [as a technique] to … control their emotions, stop ruminating on the past and prevent worrying about the future. Clients learn that racing thoughts can be stopped or slowed down with practice.”

Mindfulness-based therapy is akin to mental training, Hamrick says. “My clients learn how to train their mind so they can think about what they want to think about, when they want to think about it and how they want to think about it,” he says. “[Clients] wouldn’t tolerate their right arm suddenly going off and flailing around without their control. So why would they tolerate their brain doing the same thing? Mindfulness teaches clients to focus on the here and now rather than on the there and then and on what they can control rather than on what they cannot control.”

Hamrick also uses the Buddhist concept of impermanence, especially with clients dealing with depression, anxiety or substance abuse. “This concept emphasizes that nothing lasts forever,” he says. “It gives hope to the hopeless. There is no reason to believe that the client will always be in the same situation [he or she is] in now. Depression can be treated and overcome. A panic attack never lasts forever. And plenty of people have overcome addictions of all kinds. Once we’ve established that the situation can be overcome, then I find using solution-focused techniques will help clients develop a plan to overcome what’s facing them.”

Counseling and contemplation

Thompson has long nurtured an interest in contemplative practices, a broad term, she says, that includes both formal seated meditation practices and practices such as walking meditation and yoga. She says contemplative practices are “activities that are used to cultivate the mind and the heart.”

According to Thompson, the act of contemplation helps shift us out of a current mode of thinking to a broader, more open mode of thinking that increases our ability to understand issues. “When we are stressed out, or if a family system is under extreme stress, [our] brains are firing for survival,” she says. “Contemplation helps one relax so that the brain reorients to a more reflective and calmer place — a place where problems can be solved more easily because there are more resources available to draw from. The foundation of any contemplative technique is to focus on relaxation first, then gain stability of concentration and then advance to vividness/intensity. The West tends to focus on intensity first without understanding that … intensity is unstable” unless relaxation is also emphasized.

Both Eastern and Western mental health approaches use a form of contemplation, Thompson says, but the East has a longer history of developing those techniques. “This stems from the two different modes of inquiry that the East and West have emphasized,” she says. “The West and its modes of inquiry have generally relied on exploring reality from a ‘God’s-eye view’ or an objective standpoint through science, while the East’s more contemplative approach starts with subjective experience and phenomena, then moves out from there. This approach still asks empirical questions, but the answers are more rooted in subjective experience.”

Both the counseling profession and Eastern philosophy share a respect and appreciation for the client’s subjective, internal experiences, Thompson says, which makes them a good match for the integration of contemplative approaches. Contemplative approaches are typically present-focused, Thompson says, adding that studies have linked a contemplative mind to lower cortisol levels, lower rates of depression, fewer heart attacks and lower rates of cancer.

For clients presenting with a concrete situation that they need assistance changing, a Western approach might work best, Thompson says. For example, a Western-based counseling approach might be a better fit for a family seeking help with a child’s school-related issue, such as bullying or poor academic performance. “A contemplative approach may be more useful for issues related to the long term, more related to lifestyle or a chronic condition — for example, working with habits, chronic anger or chronic pain,” she says.

A benefit often exists to blending Eastern and Western approaches as well, Thompson says, such as when working with a client with severe depression. “I have found that addressing the depression first using a more Western counseling approach is beneficial,” she says. “For example, I might start with a person-centered approach to build a therapeutic relationship with clients and then integrate elements of cognitive behavior therapy (CBT) to help clients see the connection between their thinking patterns, behaviors and moods. I also might include psychoeducational components to help clients understand their symptoms and realize that they are not alone in healing from depression. When someone is suffering from severe depression, many things, even contemplative practices, can become tools of self-recrimination. Therefore, helping a client to break the downward spiral of depression characterized by guilt, regret and self-blame is a starting point. Then, a foundation for a positive spiral, characterized by acceptance, gentleness and self-compassion, can be laid.”

In cases such as these, Thompson says, she would gently integrate Eastern approaches at a pace that is right for each client. This gives her time to ensure she is being sensitive to the needs of the client and allows her to gain a solid understanding of the client’s worldview and beliefs. “For me, Eastern approaches emphasize returning to gentleness and self-compassion as foundations for future change,” she says. “Sometimes clients suffering from depression have a greater sense of compassion for others than they do for themselves. Helping them to see their own worth and recognize that they deserve compassion as much as others begins the process of cultivating self-compassion and acceptance.”

Treating trauma and pain

Many of the clients Del Vecchio-Scully sees are dealing with posttraumatic stress disorder (PTSD) and chronic pain. A blended approach of Eastern and Western techniques tends to yield the best results for these clients, says Del Vecchio-Scully, who is certified in integrative yoga therapy, a specialized form of yoga that can be used with clients with medical conditions.

For chronic and acute pain, Del Vecchio-Scully says relaxation and meditation techniques are key. From the Western side, she says, that can include CBT, guided imagery and dialectical behavior therapy (DBT). From the Eastern side, her chosen approaches include mindfulness, yoga breathing, Buddhist meditation, Tibetan chants and mantra. The aim of these techniques is to reduce clients’ anxiety, which can frequently accompany pain and the human tendency to guard against the pain, Del Vecchio-Scully says. “For example, if I have a sprained ankle, I will avoid putting weight on it for fear of pain,” she says. “This phenomenon actually creates more pain by creating additional tension in the muscles and tissues. When a person in pain can release this tension through relaxation, their pain decreases.”

As it relates to PTSD, Del Vecchio-Scully says counselors must have a toolbox of coping skills to help clients effectively manage and heal their trauma. Clients with PTSD often experience a cluster of arousal symptoms, she says, including insomnia, nightmares, irritability, anger outbursts, hypervigilance and an exaggerated startle reaction. These clients are often experiencing a stress response that is stuck on “on,” she says.

“The most effective approach to arousal is calming and soothing,” Del Vecchio-Scully says. “How this is accomplished is where a blend of East-West skills can be applied. Each of these symptoms taken on its own could have its own treatment approach. Insomnia, with difficulty falling asleep, could be treated with CBT and sleep hygiene as well as sleep meditation [and] self-hypnosis. Many times, trauma survivors have insomnia because they are afraid to go to sleep. In this case, identifying ways to foster safety — guided imagery, visualization, hypnosis, expressive therapies and art therapy, which can be either Eastern or Western in how they are applied — can be helpful. It truly is individualized to address each person’s unique presentation.”

Clients who have experienced trauma might present with hypervigilance and dissociation, which together can form a vicious cycle, Del Vecchio-Scully says. But teaching these clients to be present to their feelings can help them feel less afraid and threatened, she says. A Western approach of psychoeducation can be useful in addressing hypervigilance because it teaches clients about the nature of trauma, she says. Del Vecchio-Scully might then follow that up with Eastern techniques that provide restorative, calming experiences, including yogic practice and breathing, mantra meditation, affirmations and safety totems, such as hope stones that clients can carry with them.

“Another way of blending [Eastern and Western] approaches,” she adds, “is through the use of trauma-informed art therapy, which utilizes expressive arts therapies [including] yoga, art-making [and] mindfulness to stabilize mood and dysregulation often experienced by trauma survivors.”

Del Vecchio-Scully again blends East and West in addressing the dissociative piece of trauma, using Western-based progressive muscle relaxation and Eastern-based basic centering/grounding and additional yogic techniques.

One client who came to see Del Vecchio-Scully was dealing with a history of PTSD and bullying, while also struggling with fibromyalgia and chronic fatigue. Once again, Del Vecchio-Scully found a blended approach worked best. “She benefited from medication to improve her sleep and reduce pain; meditation — guided imagery, visualization and mantra — to calm and soothe herself; and psychoeducation regarding the nature of PTSD and the many ways it can present — for example, anxiety and hypervigilance, chronic pain, insomnia. In this case, medication alone would have helped her sleep without changing the cause of her pain syndrome and anxiety. She has found the meditation particularly useful in reducing her anxiety, improving mental clarity and fatigue.”

Del Vecchio-Scully also uses Reiki, a healing tradition that originated in Japan, with some of her counseling clients. The idea is that every living thing has an energetic vibration, and Reiki is one way of experiencing that life-force energy. “There are many ways to share Reiki with another,” Del Vecchio-Scully says. “It can be given through a light touch or by placing your hands close to a person’s body. It can also be shared through intention. For example, in my counseling session, I activate my Reiki vibration, which can help the client feel calmer and settled. Reiki and other energetic-based techniques help clients to assess their own well-being [and] can reduce anxiety and chronic pain. I use psychoeducation to identify [clients’] own energies and teach them methods to do so [themselves].”

Finding the client’s comfort zone

Although Eastern and Western approaches tend to come from different perspectives, these counselors say there are benefits to be gained in session by blending them according to each client’s needs. “The blending of Eastern and Western healing work is a philosophy of how I, as a therapist, approach counseling,” Del Vecchio-Scully says. “My counseling training taught me how to identify psychopathology, which is invaluable in identifying a client’s symptoms and classifying them. It gives me the starting-off point for therapy. However, the healing process begins with normalizing their behaviors, feelings and experiences as often normal reactions to abnormal situations. This clearly doesn’t include psychosis, delusions, hallucinations, intention for self-harm or harm to others. My philosophy is holistic, incorporating the mind and body, emotions and spirit using the best of the traditional Western approaches and perhaps nontraditional — though I believe this is changing — Eastern approaches. Both have value when
used with clinical skill for the client’s greater good.”

For example, Del Vecchio-Scully says, if she is using basic CBT techniques such as cognitive restructuring, cognitive reframing and challenging limited beliefs with a client, at the same time, she will ask that client to take a moment to stop and breathe. Teaching people how to be in the here and now is a basic Gestalt concept, but yoga and mindfulness practice are also steeped in that philosophy, so a lot of overlap is present, she says. “I weave mindfulness into any intervention I am doing,” she says. “It’s always about, ‘Take a breath. Let’s see if we can slow down the pace of what’s going on inside.’”

Wadhwa, who is also the program coordinator for an addictions counseling concentration at Governors State University in University Park, Ill., often allows the client to choose the best route. “I will usually introduce Eastern approaches [by saying], ‘One approach that exists is …’ This seems to work well for my clients. They ask questions, and we discuss the topic.”

For example, Wadhwa has seen clients who were dealing with transgenerational issues. “When clients recognize some pattern from generation to generation, I’ll offer the transgenerational thought of how things may be passed down,” she says. “I’ll introduce the approach of karma and how one approach believes that one generation works out the karma of the previous generation and that maybe what my client is experiencing is the cumulative effect of that karma. If this is something that resonates with the client, then I’ll offer some options on assignments geared toward this. If not, we’ll explore what elements of these different approaches fit better for the client and what [he or she] thinks may be helpful in resolving or healing this particular issue.”

These counselors acknowledge that some clients are hesitant to try techniques that incorporate elements of a traditionally Eastern approach. If Hamrick encounters a client who is unsure about meditation, he raises the point that meditation is a form of mental training. “I explain how meditation has been shown in scientific research to be beneficial in the treatment of depression and anxiety, and [how] scans of the brains of people who have practiced meditation, even for short periods of time, have shown real changes in the structure of the brain that allow for better emotional control,” he says. “When put in these concrete terms, clients typically want to try meditation.”

Thompson looks for approaches that are relatable to the client. For example, she has worked with individuals who were turned off by the idea of meditation because they thought it ran counter to their closely held religious beliefs. “It [didn’t] connect with their experience of the sacred,” Thompson says. “I want to be helpful to them in the worldview that makes sense to them, so I might ask them instead about what Scriptures provide them a sense of peace [or] what brings them calm.”

Radical acceptance, which also has Eastern themes, is another approach Thompson sometimes uses, particularly with clients struggling with perfectionism and self-judgment. At times, however, these clients resist the idea of acceptance because they have come to counseling with the idea of “fixing” themselves, she says. At that point, Thompson might switch to the technique of motivational interviewing. “Have you achieved your goals with self-criticism?” Thompson asks clients. “What would it be like to accept that this is where you’re at?”

Regardless of where counselors fall on the spectrum of Eastern versus Western approaches, Thompson believes meeting clients where they are and using techniques they are comfortable with is most important. “In order for a transaction to occur, the therapist must meet the client in his or her worldview and understanding of change and contemplation,” she says. “It takes so much courage to come to a counselor, and I want to demonstrate to my clients that I honor their courage. I want to help them alleviate the suffering that spurred them to come into counseling. Therefore, gathering information about clients, their cultural backgrounds, their family backgrounds, their worldviews and spiritual and/or religious beliefs is essential. The question ‘How would you like to try … X?’ is helpful. If the client is not interested, then I do not pursue it.”

“Most clients agree that relaxation in one form or another is helpful, so I like to start from there,” Thompson continues. “It can easily move to progressive relaxation, full body awareness or simply cultivating the wish for happiness and to alleviate suffering. A useful question related to mindfulness is, ‘What do I need to do and what do I need to stop doing in order to be happy?’ What is surprising is that answer can frequently range from mundane tasks such as doing more laundry to completely changing how one engages with reality. Contemplative approaches have something for everyone.”

Although not a common occurrence, Del Vecchio-Scully recalls one client who was concerned that yoga might run counter to her Christian faith. “I talked it through with her and supported her decision,” Del Vecchio-Scully says. “The only path is to honor and respect their feelings toward something and move on in another direction.”

Del Vecchio-Scully says she doesn’t present approaches as being Eastern versus Western with clients. “We discuss what may be helpful to them and then try to identify the right interventions for them based on personality, openness and willingness to try,” she says. “I reinforce that if one thing doesn’t work for them, there are always many options.”

Maintaining counselor identity

As more counselors begin promoting the benefits of Eastern-based approaches such as meditation, mindfulness and yoga, the public may question what counseling has to offer that meditation centers or yoga retreats don’t.

“In a meditation center, the only focus is on meditation,” Hamrick says. “In counseling, the focus is on the client feeling better. In counseling, I might use meditation as a tool to help my client, but I have many more tools in my toolbox. I think the biggest benefit that clients can get from counseling that they can’t get at a meditation center is the opportunity to talk about painful and possibly embarrassing topics with an unbiased and confidential professional.”

Counseling remains more clinically oriented as well, adds Del Vecchio-Scully. “I’ve made a diagnosis and formulated a treatment plan that includes multiple interventions based on the diagnosis,” she says. “There are different types and styles of meditation and yoga that garner different outcomes. This is where the blend of my clinical training and Eastern specialties is a distinct advantage. Within the guided imagery field alone, there are many approaches for clinical issues, and [they] are based on the written script. A nonclinician isn’t going to have this expertise. Also, [counseling clients] are getting one-to-one attention to their issues, and techniques can be modified based on their needs. This isn’t going to happen in a group setting [led] by a nonclinician.”

With the influence of globalization, Del Vecchio-Scully predicts the counseling profession will continue to experience a shift toward eclectic practice, including the incorporation of Eastern-rooted approaches. The complementary nature of Eastern and Western approaches will further facilitate that movement, Thompson adds. “Both Eastern and Western approaches share the common goal of helping people,” she says. “Eastern approaches can provide tools to help clients work with their minds and emotions to build on the changes they have made through Western approaches.”

Thompson, who has pursued trainings focused specifically on integrating contemplative practices into counseling, says many training options are available to counselors who want to blend Eastern approaches into their work. However, she says, there is no one “best” training, just as there is no one best approach to counseling.

Regardless, it is imperative that counselors have personal experience in whatever practice they might ask their clients to engage in, she says. “Do your own yoga, seek out meditation on your own,” Thompson says. “Personal exploration and practice are essential. If you want to share meditation with your clients, pursue contemplative training and practice it first. If you want to integrate mindfulness attitudes and practices into your work with clients, again, find ways to integrate them into your own life through training, retreats and personal practice. In addition, finding a community of counselors who incorporate Eastern/contemplative approaches is extremely helpful. There is a community of counselors in my area who incorporate Eastern approaches — specifically mindfulness — into clinical practice. This has been a wonderful resource and inspiration for me. Also, for clinicians working on licensure, finding a supervisor who incorporates Eastern approaches would be an excellent means of getting support.”

Hamrick agrees that personal experience is the best starting point. “Eastern philosophy is based on the individual experience,” he says. “You can read a pile of books and have a beginning understanding of Buddhism, Hinduism or Taoism. You can learn the steps of meditation and teach them to others. But if you really want to incorporate Eastern approaches into your counseling, you need to start practicing them first. Once you’ve really experienced the changes they can bring to your life, then you’ll really be ready to present them to your clients.”

“The first thing to do is put down this magazine and look around the room,” he says. “Really look without thought and without judgment and without analysis. Simply sit, look and be. That’s a good start.”

 To contact the individuals interviewed for this article, email:

 Lynne Shallcross is the associate editor and senior writer for Counseling Today. Contact her at lshallcross@counseling.org.
Letters to the editor: ct@counseling.org

Look out – and beyond: The Singularity is coming

Jeffrey T. Guterman October 1, 2011

Robotic counselors. Virtual solutions. Personality uploading.

These are not science fiction fantasies but real possibilities that lie just beyond the horizon for the field of counseling. According to some futurists, a trend of great historical magnitude is unfolding: the exponential growth of technological development leading to an event referred to as the Singularity.

Ray Kurzweil, author of the 2005 best-seller The Singularity Is Near: When Humans Transcend Biology, predicts that the pace of technological development is becoming so rapid that the rate of progress will become vertical by the middle of this century. Then, in a short period of time — perhaps in one single moment — the world may be transformed beyond recognition. It is this special point in time that is referred to as the Singularity.

The Singularity could change everything as we know it, and the implications for counseling are significant. The Singularity may challenge us to reconsider the multicultural dimension that is a defining feature of our profession. The Singularity may take disciplines such as neuroscience to a new frontier. The Singularity may also challenge the fundamental question, “What does it mean to be human?”

What is the Singularity?

The cause of the Singularity would be the creation of greater-than-human artificial intelligence (AI). As a result of advances in the development of AI and complex networked supercomputers, a positive feedback loop would result whereby smarter computers are capable of designing even smarter computers. This feedback loop would be so sudden and rapid that AI would eventually develop. In effect, machines would have consciousness and act like real people and, conversely, humans would transcend their own biology by augmenting themselves with AI.

Some futurists question if the Singularity will happen at all. In particular, some question whether a computer will ever be able to attain human intelligence. But not Ray Kurzweil! He developed the theory of accelerating returns, which holds that the rate of technological progress is exponential rather than linear. Most humans, according to Kurzweil, are linear thinkers. We understand progress as occurring in single, incremental steps (for example, 1 + 1 = 2, then 2 + 1 = 3, then 3 + 1 = 4, and so on). In contrast, exponential progress occurs when the growth rate is in proportion to current and subsequent values (1 + 1 = 2, then 2 + 2 = 4, then 4 + 4 = 8, and so on). Consider that it took about 30,000 years for humans to develop agriculture, but it took only a quarter century for the first computers, which took up the size of a large room, to be condensed into a hand-held gadget. And in only five years since its development, social media has become ubiquitous.

It is astonishing to trace exponential technological progress throughout human history and to consider where it might lead. Increasingly, people have used technologies as extensions of the self  — for example, eyeglasses, the Sony Walkman, pacemakers and prostheses. As a result of technological advances, it is foreseeable that some humans might be almost entirely nonbiological within the next 50 years. Progress in the field of biotechnology may even make it possible for humans to someday achieve immortality.

The changing nature of humanity

The Singularity may change human nature itself and raise questions about who we are and what we will become. Since the beginnings of counseling, the field has developed numerous theories of human nature. In particular, counseling has been influenced by a tradition that conceptualizes and values the self. For example, psychoanalysis theorizes that there are conscious and unconscious parts of the self. Person-centered therapy holds that there is a social self and a real self. Although these and other counseling theories disagree about how to conceptualize and intervene in relation to the self, most agree that the self is a central locus of problems and change.

Coinciding with the postmodern movement, a marked shift occurred in the field, with the self being situated in conversational, cultural and relational domains. From a postmodern perspective, the self is understood as a narrative phenomenon that is socially constructed. As technology develops exponentially in the 21st century and humans become increasingly augmented by technology, the nature of humanity itself may change and two new types of human beings could emerge: transhuman and posthuman.

Transhuman refers to a person who has become so significantly augmented by technology that, in effect, he or she has transcended the original definition, based on biology, of what it means to be human. Some people already consider themselves to be transhuman. Transhuman also refers to a human in transition who seeks to learn about new technology and might be preparing to become posthuman.

Posthuman refers to a completely synthetic entity with AI. Such beings likely could appear in the middle of this century. A posthuman is a superintelligent robot, but not the type we have become accustomed to in science fiction. Posthumans would be able to share their experiences with one another, change their bodies into data forms and choose to reside in computer networks. They might be able to think, feel and behave very much like real people. It is also conceivable that humans and transhumans will be able to transform themselves into posthumans. When considered in this way, the relationship between humans and posthumans is not about “us” and “them,” but rather about how humans may gradually transform into increasingly posthuman beings.

Implications for counseling

Many questions arise, especially for the field of counseling, if we imagine a world in which humans, transhumans and posthumans coexist. The question of what it means to be human may be thrown into critical relief as machines perform more complex human functions and as we ascribe human qualities to these machines. Even today, we refer to some of our machines as if they have personalities. For example, one might refer to his or her car as “my baby.” If computers possess AI and become superintelligent, there would be a real convergence between biology and machine. Biology would no longer necessarily define humanity. Instead, a set of characteristics and capabilities might determine what it means to be human. Among the questions that may arise for the counseling profession:

  • How might counseling be changed in a world coinhabited by humans, transhumans and posthumans?
  • What unique opportunities and problems might humans, transhumans and posthumans face in this new world?
  • How might counselors, who themselves may become transhuman or posthuman, prepare to meet these new challenges?

One possible scenario is that a human counselor encounters a transhuman or posthuman client. Or a posthuman counselor might provide counseling to a human or transhuman client. As a result of future technology, people might even possess the capability of recreating the self in ways that are unimaginable today. Software uploading to the brain, which is already being done for individuals with Parkinson’s disease, could allow one to experience and manifest alternative personalities. Personality uploading may permit an individual to be anyone or anything he or she wishes to be, presenting new challenges and opportunities for clients and counselors alike. This would challenge the traditional assumption that an essential self exists that is “just there” and instead support the postmodern understanding that the self is an evolving, fluid phenomenon.

Reconsidering our mission, ethics code and multicultural competencies

The Singularity may also challenge the American Counseling Association to one day reconsider its mission and the ACA Code of Ethics. ACA’s current mission statement is as follows:


The mission of the American Counseling Association is to enhance the quality of life in society by promoting the development of professional counselors, advancing the counseling profession, and using the profession and practice of counseling to promote respect for human dignity and diversity.


If we accept that transhumans and posthumans may someday inhabit the world, then ACA’s mission might need to be revised to account for these new beings. Moreover, a review of the ACA Code of Ethics and the Association for Multicultural Counseling and Development’s Multicultural Counseling Competencies may be needed to address the coexistence of these multiple, diverse forms of humanity. In particular, these guidelines would need to address diversity and multiculturalism from a broader perspective. The scope of diversity and multiculturalism has already been expanded beyond race, ethnicity and gender to include other domains such as age, family structure, sexual orientation and disability. As people become increasingly augmented by technology, new opportunities will arise for counselors to promote respect for the dignity and diversity of transhumans and posthumans as well as humans.

In the future, our mission, our ethical imperatives and our multicultural competencies may in some respects be no different than they are today. The Singularity may, however, require what philosopher Peter Singer refers to as expanding our circle of empathy. According to Singer, human progress has involved an expanding moral circle.

Through time, the circle of whom we count as members of our group has expanded to include other races, other sexes, other religions and other species. It is not a stretch to imagine humans accepting and embracing transhumans and posthumans. But work still needs to be done in the area of social justice strategies aimed at promoting respect for the dignity and diversity of human beings. It follows that the inclusion of transhumans and posthumans in the world would present society with challenges that counselors need to be prepared to address.

What now?

Kurzweil suggests the pace of technological change will become so fast in the next 40 years that you will not be able to keep up unless you enhance your own intelligence with AI. Already today, it is essential for many of us to access the Internet on a regular basis. Some people feel they would be lost without their smartphones. The good news is that more and more people are able to access the new technologies, and the playing field will continue to level. But are people prepared for the exponential technological change that may be coming?

Counselors are all too aware of the importance of preparing for change. Change is the business of counseling. But there has never been a change in human history like the change occurring now — a change that may culminate in the Singularity. If you observe closely, you will find many people are being affected by the sudden, rapid increase in technological change. Sociologist and futurist Alvin Toffler came up with a name for this condition, which served as the title of his 1970 book, Future Shock. In this seminal book, Toffler predicted that people would become disconnected, overwhelmed and “future shocked” as a result of accelerating technological and social change. The cause of this condition, according to Toffler, is “too much change in too short a period of time.” Basically, technological evolution is outpacing our biological capability to manage it.

We need to find ways to help others with these new challenges. Already, many counselors are dealing with technology-related issues such as online counseling and Internet addiction. But this is only the beginning. New possibilities, some of which are unimaginable today, are closer than you may think. Counselors, educators and especially students, the future of our profession, need to be willing and prepared to look out — and beyond. The Singularity is coming!

Suggested websites

Nick Bostrom- nickbostrom.com

Ray Kurzweil- kurzweilai.net

Singularity Hub- singularityhub.com

Transhumanist FAQ- extropy.org/faq.htm

Suggested readings

Human Enhancement edited by Julian Savulescu and Nick Bostrom

Radical Evolution: The Promise and Peril of Enhancing Our Minds, Our Bodies — and What it Means to Be Human by Joel Garreau

The Age of Spiritual Machines: When Computers Exceed Human Intelligence by Ray Kurzweil

The Singularity Is Near: When Humans Transcend Biology by Ray Kurzweil

Jeffrey T. Guterman is associate professor of counseling in the Counseling Department of the Adrian Dominican School of Education at Barry University in Miami Shores, Fla. Contact him at jguterman@mail.barry.edu.

Letters to the editor:

Extending the humanistic vision

James T. Hansen October 2, 2010

One of the long-standing debates in the counseling profession is whether the counseling process should be conceptualized scientifically or according to the assumptions of the humanities. At this point in history, most counselors would probably agree that both scientific and humanistic ideologies should inform the practice of counseling.

These scientific and humanities polarities can also be used to conceptualize the entire counseling profession, not just the counseling process. In this regard, I argue that contemporary counseling culture is largely structured by scientific assumptions that have had a detrimental impact on the profession. The purpose of this article, then, is twofold: to explore the consequences of grounding the counseling profession in the humanities such as literature, history and philosophy rather than science; and to demonstrate that this humanities vision is a better fit for the profession than the scientific one.

Arguably, the historical relationship between scientific and humanities influences in the counseling profession can be characterized as a complex dialectical interplay, with each force offsetting and progressively defining the other. A reasonable way to conceptualize the humanities vision, then, is to identify key scientific ideological polarities and their humanities counterparts.

Human complexity vs. human simplicity

It is a remarkable irony that contemporary counselor education tends to simplify, rather than complicate, human beings. Students often enter graduate school in awe of the sheer complexity of the human condition. Sadly, by the time they order their caps and gowns, these new professionals have been educationally indoctrinated to think of people in relatively simple terms: as technique-responsive clusters of symptoms. Of course, I am intentionally exaggerating the state of current counselor education to make my point. Remnants of human complexity certainly remain in graduate curricula. Nevertheless, I do not believe I am that far off the mark. Within counselor training programs, there exists a strong, creeping trend toward simplifying the human condition.

I contend this simplification is a direct result of the influence of scientific ideology. To illustrate this point, consider the scholarly goals of a humanist, such as a literary scholar, in contrast to the goals of a biologist, who is a dedicated scientist. The literary scholar might spend the better part of an academic career devoted to a particular author, novel or even a single character. The goal of this humanities professional is to complicate, dimensionalize and enrich the subject matter, not simplify it. The biologist, on the other hand, seeks to whittle down the subject of study to its barest elements by progressively eliminating extraneous perspectives that do not meet the instrumental needs of scientific advancement. Given their respective professional goals, the biologist and the literary scholar have selected the proper ideological tools to advance their disciplines.

Why should the counseling profession adopt a humanities ideology that complicates people rather than a scientific ideology that aims to simplify them? The brief answer (so plainly obvious it is remarkable that it is largely missed in contemporary counseling culture) is that people are, indeed, complex! To thoroughly adopt an ideology aimed at simplifying people is completely counter to everything that is known about the human condition. Specifically, the locus of human complexity resides in the subjective meaning systems that people construct. The undeniable truth that every human being has unique inner subjective experiences makes people extraordinarily complex.

Science, however, is the sworn ideological enemy of subjectivity. Scientists use double-blind procedures and other methodological strategies in an attempt to eliminate the influence of subjective bias within their studies. For scientists, subjectivity is something to be rooted out so that the conclusions of their studies will be objective. This ideological stance is perfectly appropriate for chemists and physicists of course. Indeed, scientific investigation can also be an important tool in the humanities, as when chemical analysis is used to determine the age of historical documents. It is likewise vital for the counseling profession to use science as a tool, particularly in investigating the effectiveness of counseling interventions.

Although the counseling profession absolutely should retain science as a tool, the simplifying, anti-subjectivist ideology that gave rise to this tool should not be allowed to overtake the profession. Reductive diagnostics, symptom-focused treatment planning and defining counselor education goals in terms of lists of competencies, techniques training and manualized counseling models are just a few of the many signs that an emphasis on subjective meaning systems is gradually being lost in the profession. The creeping spread of scientific ideology, and concomitant loss of a humanities perspective, is arguably responsible for this shift. Indeed, it is extraordinarily ironic that professionals who seek to understand the unique experiences of their clients would adopt an ideology aimed at eliminating the variable of subjectivity. How, though, should a humanities vision, which encourages notions of human complexity, be revived within the counseling profession?

First, discussions of clients, in case conferences, classrooms and other forums, should emphasize subjective client meanings, not symptoms, family history of mental illness, reductive treatment plans or other supposed objective case data. In discussing a client, counselors should bear a closer resemblance to English professors talking about a literary character than to chemists describing the properties of a particular compound. Of course, clients are not fictional characters; they are real people in a state of psychological distress. Alleviating that distress involves a humanities-style immersion into the realm of human complexity, not a simplifying, scientific objectification of the case material.

Second, counselor education programs should regularly teach and adopt qualitative research methodologies. Unlike quantitative research, which is aimed at finding singular, objective truths uncontaminated by subjectivity, qualitative methods are designed to illuminate the multiple strata of meaning that underlie human behavior. Quantitative research will always be a useful tool for counselors. However, a humanities vision for the profession is best served by investigative methods that explore subjectivity, not ones that eschew it.

Third, counselors should take a critical stance toward the medical model of counseling rather than uncritically participating in it. The complexities of human relating, which are integral to the counseling process, have been ideologically marginalized by the medical model of people as collections of symptoms to be eradicated. Despite its gross inconsistencies with the type of help that counselors provide, medical model training has increasingly been integrated into counselor education programs, and counselors have actively sought reimbursement from third parties that require the use of a medical model. Whether a counselor decides to participate in the medical model is a personal, ethical decision. However, counselor education programs should prepare students to think critically about this model so that it is not accepted without question once students become practitioners.

Multiplicity of perspectives vs. singular truth

Consider philosophers as representatives of a humanities profession. Critical inquiry, active debates in the literature and the consideration of multiple perspectives all contribute to enriching the philosophical body of knowledge. Philosophers do not expect that their debates will somehow march them forward to singular truth, with all philosophers one day arriving at unified agreement concerning philosophical topics. Instead, an ever-increasing multiplicity of perspectives is itself the end product, not a means to some greater end.

Alternatively, consider a medical researcher as an example of a professional who operates within a scientific ideology. Differences of opinion about the cause of a particular disease may exist among medical researchers. This multiplicity of perspectives is considered an unfortunate means to the greater end of finding the singular truth about what actually causes the disease.

I maintain the current intellectual climate within the counseling profession bears a much closer resemblance to scientific ideological assumptions, which regard multiple perspectives as a problem to be resolved, than it does to the intellectual stance of the humanities, which embraces multiple perspectives as an end in itself. Witness the general lack of public debate over ideological positions among academic counselors (both in the counseling literature and within academic settings). This is in stark contrast to the humanities, wherein active debate, both in literature and academic settings, is prized as a vital part of professional culture. Indeed, counselor educators have accepted oversight from an organization (the Council for Accreditation of Counseling and Related Educational Programs) that dictates the proper topics to teach and suitable perspectives to adopt. Widespread acceptance of this ideological police force is compelling evidence that counseling culture has become increasingly intolerant of multiple perspectives. This intolerance is not limited to academia, though.

Practicing counselors increasingly use standardized treatments for particular constellations of symptoms. One disturbing sign of this trend is the proliferation over of the past decade of treatment planning guides, which detail precise, concrete treatments and goals for particular categories of clients. This unfortunate development, which has been fortified at the academic level by the “empirically supported treatment” and “best practices” movements, is as stifling to counselors as the demand to use only paint-by-numbers kits would be to artists. Furthermore, counselors are being told not only how to practice but who to be. Those who promote a unified identity for the counseling profession have attempted to outline the proper identity for professional counselors to adopt. Counselors who wish to expand their horizons can make use of continuing education, but only if an accrediting body has approved the content of the continuing education experience. To become a counselor nowadays, one must agree to don an ideological straitjacket. How, then, can the culture of counseling be changed so that multiple perspectives will be encouraged?

First, active debate should be promoted in academia and in the counseling literature. One of the best ways to foster an appreciation for multiple perspectives is for professionals who advocate different points of view to engage in civil public debates (both in presentations and in the literature). A public airing of differences clarifies ideas, elucidates the nuances of systems of thought, challenges professionals to think in novel ways, generates new perspectives and, perhaps most important, demonstrates that there are multiple legitimate ways to understand the subject matter of counseling.

Second, and related to the first point, theoretical dogmatism should be discouraged at all levels of the counseling profession. Students should be taught that counseling consists of a variety of useful perspectives. No one perspective should be idealized or used for all purposes. Similarly, practicing counselors should view counseling orientations as problem-solving tools, not representations of ultimate truths about human nature.

Third, continuing education should not be professionally mandated. As an analogy, imagine if authors of fiction were required to read a list of approved works before they were allowed to write. If a humanities atmosphere is to be created in counseling culture, practicing counselors, not bureaucrats, should determine the types of postgraduate educational experiences that best suit their needs. It is a shocking assault on intellectual freedom and growth, for example, when only one article in an issue of a particular journal is officially sanctioned as being eligible for continuing education credit. This implies that all other readings are somehow less intellectually worthy of professional attention. The need for continuing education should be an internalized ethic instilled in counseling students during graduate school, not an external mandate that limits and controls the types of educational experiences that counselors pursue.

Fourth, professional limitations should not be placed on counselor identity. Any proposal for a unified professional identity is, by definition, also a proposal that negates certain types of identity possibilities. Counselors should be encouraged to determine their own professional identities, which may be based on their personal temperament, local demands, orientation to their work or any other considerations they deem relevant to their professional life.

Discussion and conclusions

Science is a vital tool that will always be a necessary component of counseling inquiry. However, the counseling profession should be ideologically grounded in the humanities, not science. The scientific ideals of parsimony, singular truth and objectivity cannot possibly facilitate the evolution of a profession that historically has made its greatest advances by embracing complexity, multiple meaning systems and creative visions of human nature.

I have made the following recommendations for shifting professional counseling culture from a position of simplicity and singular truth to one of complexity and multiple perspectives:

  • Discussions of clients should emphasize subjective client meanings, not objective data.
  • Qualitative research should become a standard method of inquiry.
  • The medical model should be subjected to more intense critical scrutiny.
  • Active debate over perspectives should be professionally encouraged.
  • Theoretical dogmatism should be discouraged.
  • Continuing education requirements should be abolished or radically revised.
  • Professional identity should be self-determined, not professionally mandated.

Of course, there are other ways to encourage the spread of a humanities vision in the counseling profession (abolishing the infantilizing and draconian practice of mandated supervision, for instance). The seven recommendations listed above seem like a reasonable place to start, however. In keeping with a humanities vision, I sincerely hope these recommendations will engender controversy and debate.

James T. Hansen is a professor and coordinator of the Mental Health Specialization in the Oakland University Department of Counseling. Contact him at jthansen@oakland.edu.

Letters to the editor: ct@counseling.org

A natural resource

Jonathan Rollins October 20, 2009

Early on in her career as a professional counselor, Sally Atkins was working with a client who was suicidal and experiencing severe depression. Progress was painfully slow, and after several sessions, Atkins feared she and the client had reached an impasse. “As a kind of last resort, I said out of my frustration, ‘Let’s just go hiking and talk in the woods.’ I simply had this instinct that she needed to move because she was so stuck in her life,” remembers Atkins, a member of the American Counseling Association.

Atkins had occasionally taken brief walks with other clients to help put them at ease, but this was not a typical stroll in the park. The two women embarked on a strenuous hike that lasted nearly six hours. And out on the trail, in the open air, they were finally able to capture the sense of forward movement that had eluded them in the confines of the counseling office. “I felt like something happened by virtue of us being out there,” Atkins says. “It was a marathon therapy and sharing session.”

After finishing the impromptu outdoor adventure, Atkins asked if there was anything the woman could take from the hike and apply to the difficulties she was facing in her life. “Just being outside gave her a sense of emotional comfort, and she said her problems felt small when compared with the immensity of the natural world,” Atkins says. “She was proud of the physical strength she had shown on the hike, and it made her think that perhaps she also had the emotional strength to keep going when things were rough in her life. The experience also made her realize she needed to take one step at a time rather than focus on the enormity of the whole problem. That was a major shift for her. After that experience, she was more willing to explore new possibilities and found new energy for dealing with her life.”

The experience also signaled a shift in Atkins’ approach to counseling. “It really was a turning point for me in becoming more interested in and aware of the connection between nature and mental health,” she says. Atkins went on to develop the first class in ecotherapy for graduate counseling students at Appalachian State University in Boone, N.C., where she is a professor of human development and psychological counseling and coordinator of expressive arts therapy. “In teaching and in counseling, we (Atkins and ACA member Keith Davis, her coinstructor for the ecotherapy class) use nature-based experiences to help clients and students find resources for personal growth and development and to enhance their experience of relatedness with each other and with the non-human world. We see the processes of change as observed and experienced in the natural world as a model for human change and growth. … It’s not for every client or every situation, but so many clients and students tell us that they take solace in nature.”

Outside the office walls

When Rick Carroll broke into the profession in 1993, many of his clients were juveniles receiving court-ordered counseling. “I noticed right away that they didn’t want to be there,” he says. “I also noticed that if I put down my pen and paper and walked outside with them, the whole stigma of counseling kind of flew out the window. Taking them outside the walls of the counseling office was beneficial.”

Today, Carroll is a licensed professional counselor with his own private practice, and he also provides counseling services for the Children’s Advocacy Center of Bristol/Washington County, Va. Rare is the day that he doesn’t get outside with clients, either providing walk-and-talk therapy sessions at a wetlands park near his office or leading an experiential counseling group for adolescent boys. Typical group activities include caving, golfing and navigating a high-ropes obstacle course.

Carroll is a believer in incorporating nature into the counseling process for a variety of reasons. On one hand, he says, being out in nature rather than inside a counseling office can make the therapeutic process feel less threatening to clients. Many of Carroll’s clients are children who have been abused, neglected or exposed to domestic violence situations. “Eye contact can be very intimidating for these kids – or for any client for that matter,” says Carroll, a member of ACA. “If they’re not having to look you in the eye, they have a greater chance of disclosing. They want to tell their stories, and walking in the park or engaging in some other activity outdoors as we talk makes it easier for them. Going outside is not a panacea for everyone’s problems, but it gets them into a place that’s neutral.”

On the other hand, Carroll has found that being outdoors typically enhances the rapport-building process with certain tough-to-reach clients, particularly those young men who don’t consider counseling to be “masculine.”

“Most adolescents don’t think they have any problems that they need help with,” he says. “But when you’re out in nature, that includes insects and reptiles and poisonous plants. Kids kind of think of it as a risky thing, and that appeals to them. Some of the best counseling sessions I’ve had were with kids who didn’t even realize they were in counseling because we were outdoors.”

In fact, Carroll says with a laugh, the outdoor activities that are central to his experiential approach have made counseling sound very appealing to certain adolescents. In the course of counseling, Carroll took a middle-schooler on an outing to a cave. The next time Carroll dropped by the school, one of the boy’s friends approached Carroll and said, “I need to come see you. I’ve got some problems.”

Carroll also incorporates nature into his work with clients of all ages because of its versatility and flexibility. “Reality therapy, choice theory, behavior modification – you can pull from any number of approaches and use them in conjunction with nature,” he says. “I’d like to see more counselors add nature to their toolboxes. I’d like to see it recognized as a legitimate intervention and acknowledged as a resource that can help a variety of issues.”

Reeling kids in

Barbara Flom, an associate professor in the University of Wisconsin-Stout School of Education, believes school counselors could and should make better use of nature in their work with students. “It’s a huge untapped resource. Nature is free, it’s available, and our kids really need it,” says Flom, an LPC who is a member of both ACA and the American School Counselor Association. “As a school counselor for 15 years and, before that, a teacher of children with emotional and behavioral disorders, I observed the powerful calming and focusing effects of nature with a wide variety of students. I didn’t know then about the research on nature’s therapeutic benefits, but I saw its impact firsthand with my students. Most of the research is targeted at reducing aggression and building social skills, particularly with kids who are struggling with behavioral issues or feelings of connectedness.”

As a school counselor, Flom helped to run a Hooked on Fishing program that brought students outdoors to fish at the town lake. The program proved successful on a number of levels, from modifying behavior and improving students’ academic performance to helping students develop social skills and a sense of connectedness to their peers. For instance, the school’s Anglers Club targeted a group of fifth-graders who were chronically behind academically. “Each week in spring, if these students managed to be on track with their homework, they went fishing off the lake bank behind our school during the Friday noon hour,” Flom says. “They made their goal every week. The outdoors can be a powerful motivator.” Some of the school’s most challenging students were assigned to maintaining the fishing equipment and came to Flom’s office to restring the fishing poles. “Students who had been on the margins academically, socially or behaviorally really shone as leaders and role models in the natural setting,” Flom says. “We can really empower those kids who are connected to the outdoors by showing them that their skills are valued.” In addition to acting as a behavior incentive, she says the program served as a resiliency and coping tool for many of the children.

In some instances, the outdoors can help level the playing field for students who don’t feel as though they measure up socially or academically. “The (Hooked on Fishing program) was a great equalizer,” Flom says. “You could have a Ph.D. or be nonverbal, but the fish didn’t know that.”

Another school counselor in Flom’s area currently runs an after-school fishing program and has noted that many of the students who participate are not involved in any other school activity. “He’s using the program as a bridge-building opportunity for these students,” she says. “It gives them a place to fit in and find connection and a reason to want to come to school in the morning. As school counselors, we’ve got to find ways to reel in these students who aren’t connected socially, who are struggling behaviorally or academically, and nature can often provide us that window.”

A habitat for healing and growth

Counselors and other helping professionals are missing out when they don’t recognize the valuable role the natural world can play in the healing process, says John Swanson, a longtime ACA member who is recognized as a pioneer in the field of ecopsychology. “Nature can be a wonderful sanctuary for the healing of grief and loss. It can also heal us emotionally, in part because nature is nonjudgmental,” he says. “It can accept and receive all of a client’s feelings and pent-up energies, no matter how raw.”

Swanson, the author of Communing With Nature: A Guidebook for Enhancing Your Relationship With the Living Earth, recalls one instance in which he was running a men’s group and seeing group members individually. One of the men had made his fortune in the fish industry in Alaska but had seen his marriage dissolve in the process. In addition, as a boy, an older sibling had sexually abused him while his parents turned a blind eye. Raised in a puritanical, immaculate and orderly home, he had never learned how to deal with his anger, so it continued to build and fester throughout his adult life. Now an imposing man standing 6 feet 4 inches tall and weighing in the neighborhood of 260 pounds, he had a problem with pent-up rage.

“I tried to figure out a way to help him get his rage out without him destroying my office,” Swanson says. “So we created a plan.” The next time the man came for counseling, he told Swanson, “The plan worked out great. I went to the beach and rearranged furniture.”

What the man had done was visit a deserted beach in winter along the Oregon coast, where he proceeded to spend the night tossing large pieces of driftwood back into the roaring surf. The driftwood, Swanson explains, represented the home furniture the man would have liked to have taken his anger out on because of what had happened to him. “He also tossed ‘mom’ and ‘dad’ into the surf – figuratively,” Swanson says. “Truly letting his rage out would have been unsafe and socially unacceptable in a lot of places, but this allowed him to finally begin releasing some of the anger from his life and move forward again.”

Carroll has occasionally employed a similar tactic with young clients who have experienced abuse or who have problems processing their anger. For instance, he and the client might walk through the woods pretending to be samurai warriors. The client can then use his “sword” (a large stick found during the walk) to strike at objects in his path, releasing some anger in the process.

Many individuals who were abused or bullied or felt alienated escaped to nature as a form of sanctuary when they were children, Swanson says. “And as adults, I prescribe that back to them – retreating to nature to find comfort, healing, answers.”

In other cases, nature provides the proper setting for clients to achieve a fresh perspective, embrace new possibilities and discover (or rediscover) long-hidden strengths and sources of joy. Swanson, who himself embarks on an annual vision quest to “reorient my life and review how I’m doing,” recalls leading a therapy group composed of adult children of dysfunctional families. After 10 weeks of group sessions, the group went on a weekend retreat along the Oregon coast, where they participated in outdoor activities together. One of the group members was a librarian in her 50s. “When we were out on the beach, she just took off running,” Swanson says. “She was like a gazelle, graceful and quick as she ran in and out of the waves. She had a delightful smile on her face, which was such a contrast to the woman we had known in group. As a child, she had escaped the oppression of her dysfunctional family by running wild and free in her outdoor activities and after-school sports. This romp on the beach became a turning point for her. She began to take more risks and pursue more opportunities to embrace again these kinds of embodied physical activities that allowed her to reclaim that sense of abandon and freedom she had lost as an adult.”

“The natural world is the most common environment for what (Abraham) Maslow described as peak experiences, as well as for growth experiences,” Swanson asserts. “Our sense of awe in nature is often so powerful that we can be transformed by it.”

Carroll possesses similar beliefs concerning nature’s ability to effect positive change in clients. Eight years ago, he started a group called Compass for adolescents who have been abused or neglected. The group mixes experiential, cognitive behavioral and narrative therapy approaches, and group members spend several sessions discussing family dynamics and setting goals. The group also places a heavy emphasis on outdoor team-building exercises. Activities include exploring a cave with a certified spelunker and navigating a high-ropes course 40 feet in the air.

“Many of these kids’ lives are saturated with chaos and stress,” Carroll says. “When I take them out of that environment and put them into nature where they can see wildlife or the wonder of a cave, those events create the peak experience moments that Maslow talked about and, for the moment at least, nothing else matters to them. I believe there are spiritual, psychological, social and biological components to being out in nature, so this approach to counseling is also holistic.”

Even proponents of incorporating nature into the counseling process admit that it is difficult to put an empirical measure on its effectiveness in treating common problems such as depression. However, based on pre- and post-testing, individuals in Carroll’s Compass group generally get along better in school, exhibit more mannerly and compliant attitudes at home and show increased self-confidence overall after completing the program. Thanks in part to those measures of effectiveness, Carroll has been successful in securing funding for Compass for eight years, with nearly 60 adolescents completing the program during that time.

Feeling disconnected

“It’s interesting to me that when I talk with people who are battling depression and ask them about the times when they feel least depressed, they talk about when they go on walks or on vacation,” says Keith Davis, as associate professor and coordinator of the clinical mental health counseling program at Appalachian State. “And you very rarely hear someone say they spent their vacation in a high-rise. It usually involves some sort of outdoor element or activity. To me, that suggests an innate pull to the outdoors.”

In addition to being a counselor educator, Davis provides counseling to clients experiencing anxiety or depression. He likes to conduct imagery work with these individuals, asking them to describe a special place where they feel best. “I swear, 100 percent of the time, that place is in the outdoors, sitting on a mountaintop or by a lake,” he says. “It’s always tied to nature. It’s never, ‘I’m sitting in my living room or in my car.’ Still, I don’t think we understand how deep nature’s impact really goes.”

A growing literature base is exploring not only nature’s potential for addressing certain behavioral, psychological and emotional problems but also the possibility that society’s growing disconnect with nature is a major contributor to – if not the direct cause of – many of those problems. In his influential book Last Child in the Woods published in 2005, journalist Richard Louv compiled a wide body of research and coined the term “nature-deficit disorder” in proposing that direct exposure to nature is essential for healthy childhood development as well as the overall physical and emotional health of individuals of all ages. “Nature-deficit disorder describes the human costs of alienation from nature, among them: diminished use of the senses, attention difficulties and higher rates of physical and emotional illnesses,” he wrote.

In addition to attention-deficit concerns, Carroll has noticed a rise in Asperger’s-type symptoms, including social isolation and an inability to judge social cues, among his adolescent clients. Like many professionals, he believes a link exists between these problems and adolescents’ increased exposure to cell phones, computers, iPods, video games and other technology.

In working with these clients, Carroll often takes them outdoors and has them sit down, close their eyes and describe what they hear. “These ADHD kids who supposedly can’t attend to anything suddenly stop and look around in awe,” he says. “It calms them down and grounds them. It soothes them. I think it’s more of a spiritual thing than an emotional thing.” Atkins believes individuals from every age group are at increased risk of having their senses numbed because of technological bombardment. “That’s why it’s important for counselors to tap resources that are inherent in the natural world to help people who are struggling,” she says. “We live in a time and a culture where we live separate from nature. But being in the natural world calls us to be present in a sensory way that enlivens us both emotionally and physically.”

Adds Swanson, “Counselors need to look for opportunities to extend (Martin Buber’s) I-Thou mode beyond our species and help clients reconnect with their surroundings. It’s prescribing them to get out of the rat race and smell the flowers, to bicycle to work rather than spending time in their car bubbles, to create beauty in the home by spending more time gardening.”

Swanson says modern culture has cut most people off from the natural rhythms of life, creating a sense of disharmony in the process. “We’re not going to be happy campers if we’re out of synch with nature,” he says. “We’d be much better off if we started the day watching the sunrise and ended the day watching the stars rather than watching TV, listening to the birds sing rather than listening to the radio. These natural cycles are much more soothing and organic than following digital clock time and chopping everything into minutes and seconds.”

Whether addressing graduate counseling students or working with clients, Atkins emphasizes the importance of learning not just about the natural world, but from it. “One of the fundamentals is observation,” she says. “Watching the natural world, the changing seasons, can teach us about change and the seasons of life. Sometimes, as a society, we think we need to have constant daytime to be productive. But it’s also beneficial for life to lay fallow sometimes.”

Davis raises the possibility that a renewed emphasis on “natural” education could result in fewer students being branded with an ADHD label. “I don’t think the traditional public school education and structure is consistent with the learning style of all kids, especially young boys,” says Davis, who started his counseling career as a school counselor. “I won’t go so far as to say that our growing disconnect with nature is the cause of depression and ADHD, but when I see boys out in nature, they’re not required to focus on any one thing. Instead, they can just focus on being outside in the elements. It’s active and action-oriented learning, and there’s no judgment placed on their level of interaction.” In fact, Davis is inclined to believe that society’s growing disconnect with nature has led to much of the dissatisfaction and disorientation that many people feel in their lives. “I go back to the idea that I think there is an innate instinct in people that calls them to nature, that is imbedded in our genetic code,” he says. “As we have gone from a tribal society to an agricultural society to an industrial society and now to a technological society, we’ve moved further and further away from our relationship with the natural world. But many people still yearn for that connection instinctually. However, they don’t necessarily relate that connection – or that lack of connection – to their overall wellness. We’re seeing some emerging literature on wellness in the counseling field, and part of wellness is living in harmony with your environment.”

A paradigm shift

That concept of living in harmony with the environment is especially important to Davis, Atkins, Swanson and other proponents of ecotherapy. As described by Atkins, ecotherapy takes the ideas inherent in ecopsychology – an integration of ecology and psychology – and applies them to therapeutic practice.

In an article in press for the Journal of Creativity in Mental Health on ecotherapy (“Ecotherapy: Tribalism in the Mountains and Forests”), Atkins and Davis write: “We hold the conviction that our connections with nature and the environment are vitally important for our personal well-being and for the well-being of the planet.” They later add that “The paradigm of ecotherapy posits that personal health is related to the health of the planet, not just physically but psychologically and spiritually as well.”

“The idea that personal mental health is not just the matter of an isolated individual but is related to the health of the planet is a crucial idea and challenges the assumptions of modern science,” Atkins tells Counseling Today. She adds that ecotherapy is in tune with indigenous cultural knowledge and healing practices, including those beliefs that preserve practices of environmental sustainability and connectedness to nature. Atkins and Davis point out that this emphasis makes ecotherapy a potentially attractive alternative for clients who struggle to find meaning or healing in traditional, Western-based counseling approaches that primarily focus on the individual as separate from the natural world.

Swanson, whose research led to the publication of “The Call for Gestalt’s Contribution to Ecopsychology” in 1995 in The Gestalt Journal, is of the same mind. “The navel-watching approach to counseling can be overly introspective,” he says. “We can build better therapy by helping clients to explore their extrospective relationships.”

“We sometimes get stuck with the concept that mental health exists between our ears,” he continues, “but in family systems theory, we look at how relationships can help our mental health. The next leap forward is to broaden this to include all of our relationships, including the human-nature relationship. It’s essentially moving to a living systems approach from a family systems approach. If our relationship with the natural world is healthy rather than abusive, then our human relationships are more likely to be healthy as well.”

Both Swanson and Atkins are adamant that ecotherapy not be viewed as simply another subspecialty of counseling. “It’s really a paradigm change – one that I’m hoping will become central to what we do,” Swanson emphasizes. “If we shrink this down to a subdiscipline of counseling or psychology, we’re doomed.”

The ecotherapy class that Atkins and Davis teach at Appalachian State explores how experiences in nature can lead to personal healing. Atkins says students have described the class to her as life changing, and many have gone on to incorporate nature and ecotherapy ideals into their own practice as counselors. “The class gives them a renewed appreciation of the power and beauty of the natural world and its application to their own self-care as well as to the care of clients,” she says.

In addition to participating in classroom discussions, students design personal medicine shields throughout the semester – an activity that reflects a tradition within the Eastern Band of Cherokee Indians, many of whom reside in a designated territory near Appalachian State. In making the shields, students collect items from nature and assemble them in whatever way they choose. “Traditionally, these shields were power objects that evoked a person’s strength, courage and vision,” Davis explains. “They always end up very unique to the student. They are something to remind us of who we are in the deepest sense and how we are connected to the natural world.”

The ecotherapy class also takes a field trip each year to engage in and design nature-based experiences and activities. Last year, students were challenged to build structures to survive in the woods. “Then we talked about how empowering that was,” Atkins says, “and discussed the symbolic applications to other areas of our lives.”

Speaking metaphorically

Many counselors, including those who rarely step foot outside the office, testify to the effectiveness of using symbol and metaphor to speak to clients on a deeper level. But perhaps nowhere is metaphor more powerfully presented than on nature’s stage, from the changing of the seasons to the caterpillar’s metamorphosis into a butterfly.

“The big lesson of nature is that everything is cyclical. That can be both comforting and scary,” says Atkins. “Regardless, nature has this way of putting our little individual, ego-centered stories into the bigger picture.” One of Davis’ favorite counseling techniques is to take groups to a stream or river, where he asks each individual to find a rock or stone proportionate in size to the challenge he or she is facing in life. Afterward, he asks group members to carry their rocks with them as he leads them on a hike. “It’s a metaphor to show them how their life challenges, the problems they hold on to, are weighing them down. It gets them thinking about ‘What choices do I want to make?’ If they come back with a pebble, I have them put it in their shoe,” Davis says, “because even the smallest little thing can be nagging at you and affecting every other area of your life. When they finally say, ‘I can’t go on any longer,’ I say, ‘OK, are you ready to let that rock go?’ or even ‘Can I carry that rock for you for a while?’ For some people, the lesson is that they need to be willing to let others help them with their burden.”

The exercise holds a different lesson for other individuals. On multiple occasions when leading families through this activity, Davis says, a mother or a father has volunteered to carry all the rocks as their family members get tired. “The question then becomes what’s the price you’re paying for carrying everyone else’s problems?” Davis says. “It provides them with a lesson about how that action affects their overall wellness.”

In his experience as a counselor and counselor educator, Davis says, both clients and graduate students have professed a fear of nature. “But I think a lot of getting people out into nature is helping them to get over their fears, expand their comforts zones and tap into some resiliency and strength they didn’t necessarily know they had. It’s exploring what their fear is really about. In many cases, their fear of some element of nature is very symbolic of fears and doubts that are paralyzing them in other aspects of their lives. It’s simply a window into something bigger.”

Atkins realizes that although many counselors may be interested in incorporating nature into therapy, they may also feel intimidated by the prospect of where or how to begin. “I don’t think you can take any client somewhere that you don’t go yourself, so I would first encourage counselors to get out there and experience the healing power of nature themselves,” she says. “I would also emphasize that the process of helping a person be more connected to nature can be really simple. It doesn’t have to involve a hike up a mountain. It can be simple and yet have layers of meaning. It can be symbolic and cleansing. There’s just no cookbook for this. Irving Yalom said to create a new therapy for every client, and nature offers us a world of opportunities to do just that.”

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