Tag Archives: workplace stress

Counseling girls and women in the current cultural climate

By Tracy Peed, Crissa Allen, Mary A. Hermann, J. Richelle Joe and Anna M. Viviani May 5, 2022

This piece is the second of a three-part series for CT Online. It is the result of the work of ACA President S. Kent Butler’s Gender Equity Task Force. The first article, “Breaking the binary: Transgender and gender expansive equality,” was published on April 4 and the third article “The effects of gender socialization on boys and men,” was published on June 15.

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In this article, we highlight gender equity issues that impact girls and women and provide recommendations for counselors who work with this population.

Complex realities of girls and women

Girls and women experience complex realities. Despite their increased opportunities in the past several decades, they face pervasive limiting gender norms. For example, girls and women are still dissuaded from entering STEM fields and encounter a “chilly climate” in STEM classrooms, resulting in significant underrepresentation in STEM fields. Furthermore, girls and women with additional marginalized identities experience heightened challenges.

The supergirl and superwoman ideals permeate popular culture and media. Selective, digitally altered social media posts send the message that the superwoman ideal is achievable, and even easily accessible. The narrow construct of feminine beauty further complicates these messages. Girls’ and women’s socialization to “have it all” has become more difficult, with work hours continuing to increase in many professions as technology creates new norms related to worker availability.

In addition, women engage in the invisible work of navigating the gender bias that remains prevalent in the workplace. Women still earn significantly less than men for the same work, and this reality is compounded by racism. For example, white, non-Hispanic women who work full time earn 79% of what white, non-Hispanic men earn, whereas African American women earn approximately 64% and Hispanic women earn 57% of what white, non-Hispanic men earn. Adding to this challenge, negotiating a higher salary is more complicated for women because it defies social stereotypes.

Women who are mothers have experienced heightened parenting expectations in recent decades. They engage in more child-centered activities than mothers did in the 1960s, a time when most mothers of young children did not work outside of the home. Yet, prior to the COVID-19 pandemic, almost 75% of mothers of young children worked outside of the home.

Working mothers in the United States attempt to meet societal motherhood expectations while maintaining employment without the supportive infrastructure found in almost all other industrialized countries. The cost of child care often exceeds the cost of rent. Paid family leave is not available in many work settings, driving 25% of mothers back on the job within two weeks of giving birth. And despite the lack of paid family leave, the promotion of breastfeeding as imperative is a message new mothers receive from almost everyone today, including medical professionals — a puzzling phenomenon in light of contradictory studies on the benefits of breastfeeding. Even women who adopt their babies experience pressure to breastfeed. Women experience judgment and shame if they are not in a position or choose not to breastfeed, which can lead to negative mental health outcomes.

Why now: Refocusing on the needs of girls and women

Although men have increased their participation in household activities in the past few generations, the second shift still falls primarily on women. Furthermore, expectations related to second-shift activities have continued to rise in what Susan Douglas and Meredith Michaels call the “Martha Stewartization of America,” where women are judged on their parenting and the appearance of their homes under these elevated standards while men are not. In fact, men are often glorified for participating in basic parenting activities, which Anne-Marie Slaughter called the “halo dad syndrome.”

Intersectional identities add new layers to these challenges. For example, girls and women who identify as part of the LGBTQ+ communities are vulnerable to increased risk of depression, anxiety and suicide as a result of discrimination. Although the need for mental health services is high, members of these communities often experience a disproportionate lack of access to these resources.

According to the cultural narrative, women are expected to navigate discrimination, harassment, rising work hours, increased motherhood expectations, heightened second-shift cultural standards and current unattainable beauty ideals without ever asking for help. Many women blame themselves when they believe they are failing to meet societal standards, but in reality, the cultural system is failing them.

Similarly, girls and women encounter sexism, bullying, sexual harassment and toxic body image messages. They are encouraged to take advantage of all opportunities and to strive to be perfect at everything. Thus, they are socialized to reach for impossible standards of success. Social media often intensifies these messages.

Yet benefits of social media exist as well. Some girls and women have found supportive communities through social media, which have provided them new channels toward justice and change. Since its inception in 2006 by Tarana Burke, the #MeToo movement has promoted empowerment and support for girls and women who have experienced sexual violence. The social media hashtag has evolved into real-world measures of accountability for aggressors, notably in the entertainment industry. Use of social media for revealing information on sexual abuse does, however, have repercussions. Girls and women have cited instances of harassment, stalking and bullying on the web after posting the hashtag, leading to increased isolation, grief and retraumatization.

The COVID-19 pandemic has exacerbated many of the challenges girls and women encounter. Gender inequities in the United States are further exposed during the crisis. For example, mothers experience a higher burden in managing family life during the pandemic. In the early days of the pandemic, most working mothers lost their access to child care and other support systems. Even two years into the pandemic, isolation and quarantine mandates continue to disrupt the availability of child care on a regular basis, including the child supervision provided by schools.

The pandemic-related challenges have lingered far longer than expected, often resulting in significant mental, physical and emotional fatigue. Not surprisingly, the pandemic negatively affected women’s workforce participation. In 2019, women accounted for approximately 50% of the U.S. labor force; by the end of 2020, there were 2.1 million fewer women working.

As women were leaving the workforce at alarming rates, men’s workforce participation increased. Systemic racism exacerbated these gender inequities. African American women experienced an unemployment rate of approximately 41%, and Latinx women experienced an unemployment rate of over 38%. While the economy improved in 2021, less than 50% of these women returned to the workforce. For many workers who remained employed, on-the-job hours increased as staffing shortages grew.

Culturally responsive counseling with girls and women

Although it is important to understand the various challenges that girls and women may experience, it is also critical to avoid assumptions and stereotypes related to gender when counseling girls and women.

Identifying as a girl or woman is just one aspect of an individual’s multifaceted identity. The combination of various intersectional identities coupled with one’s environment ensures that individuals have vastly different life experiences. Furthermore, one’s identities may result in more collective privileges, compounded marginalization or a mix of both.

Therefore, it is important to understand not only a client’s gender identity but also their other social and ethnic group identities and how these various identities intersect and influence aspects of a client’s life. It would be unjust to assume that a white, upper-class, heterosexual, cisgender woman has had the same lived experiences as a Latinx, working-class, pansexual, transgender woman. As counselors, we need to be mindful of and provide an accepting space for women to explore the development of their multiple identities in counseling.

When working with girls and women, counselors need to consider several salient concerns regarding career interests, such as career choice alignment with familial and cultural expectations, traditional versus nontraditional career choice, as well as navigating harassment, bias, the glass ceiling and the gender pay gap. Tread carefully in this work, and remember that people put limits on themselves in the career domain based on their self-concept and their belief that they are a fit for or could do a particular job.

Girls and women are likely to engage in circumscription, eliminating careers that appear too masculine in the eyes of society or seem unsuitable or out of reach of their capabilities. Or girls and women compromise, selecting or short-listing careers that they see women within their social environment pursuing. Counselors must strive to monitor girls’ and women’s reactions and responses to and support of career-related endeavors, recognizing that they may be trimming their options based on the counselor’s response.

It is important to use gender-neutral language and present a wide array of potential options when introducing and exploring jobs/careers. Being a girl or a woman can come with a multitude of career expectations, relationships and society. Counselors provide women with an environment to process their numerous roles, determine if role strain or role conflict exists, and work together to navigate role-related issues based on the client’s authentic choices.

Counselors must consider how to be more gender aware, attuned and affirming in their approaches and interventions. Many postmodern approaches and theories lend themselves to this aim. The following are a few to consider alongside your current approaches. Keep in mind that this list is not exhaustive; a search of multicultural and social justice-oriented theories will provide a more extensive list.

  • Multicultural counseling and therapy acknowledges all individuals as cultural beings and, as such, their various cultural identities, values and biases are an important part of the counseling process.
  • The Multicultural and Social Justice Counseling Competencies provide additional support for working with a diverse clientele.
  • Feminist therapy allows counselors to view clients and their concerns through a lens that incorporates concepts of gender, power, privilege and oppression.
  • Relational-cultural theory focuses on finding identity through relationships and culture as a powerful influence on these relationships.

By shifting their approach, counselors create culturally responsive ways to meet the growing needs of girls and women.

Advocacy interventions with girls and women

In addition to counseling individuals and groups, advocating for clients is a vital and necessary part of our practice. Advocacy can occur on multiple levels, ranging from micro to macro. A counselor can engage on behalf of the client or with the client/group, with an overall goal of empowerment and eliminating individual and systemic barriers and oppression.

At the individual level (microlevel advocacy), the focus is on empowerment interventions with or on behalf of individual clients. Advocacy might include activities such as negotiating inequitable child care and second-shift expectations in a relationship. Counselors can navigate these actions using theoretical approaches and interventions that allow for identity development, are strength-based and are focused on empowerment.

Counselors may observe girls and women struggling with similar issues. Although counselors will likely work on individual empowerment, larger scale intervention may be needed to address more pervasive systemic issues. In this midlevel advocacy, counselors would advocate for community change with and on behalf of girls and women. Examples of community-level advocacy include advocating in schools against unfair dress code policies that marginalize girls, advocating at the local school board for curriculum to support girls and young women in mathematics and science, and advocating to local employers to support women’s needs from health care to child care in the workforce.

Although not all counselors feel comfortable or ready to advocate on a systems level, they are strongly encouraged to note their clients’ needs and get involved. Even a small advocacy endeavor has a ripple effect.

It is therefore important to know and understand the issues facing girls and women, not only in your community but also at the state, national and international level. We can all advocate for just social policies and strive to dismantle systemic inequities experienced by girls and women, such as lack of affordable access to quality health care and child care, the minimal amount of paid family leave and support for working mothers, pay inequities and work/career barriers.

For more help with advocacy initiatives, consult the ACA Advocacy Competencies for guidance.

 

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Find out more about ACA’s Gender Equity Task Force at acagenderequity.weebly.com

 

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Tracy Peed is a licensed professional school counselor in Illinois and Minnesota, an assistant professor and doctoral coordinator in the Department of Counseling and Student Personnel at Minnesota State University, Mankato, and a member of the ACA Gender Equity Task Force. Contact her at tracy.peed@mnsu.edu.

Crissa Allen is a doctoral student at East Carolina University and a licensed clinical addictions specialist associate. Contact her at allenc13@students.ecu.edu.

Mary A. Hermann is a licensed professional counselor, a certified school counselor, an associate professor in the Department of Counseling and Special Education, and affiliate faculty in the Institute of Women’s Health at Virginia Commonwealth University. She is the co-chair of the ACA Gender Equity Task Force and founder and director of the Women’s Lifespan Development Research Lab. Contact her at mahermann@vcu.edu.

Richelle Joe is an associate professor in the Department of Counselor Education and School Psychology at the University of Central Florida. Contact her at jacqueline.joe@ucf.edu.

Anna M. Viviani is an associate professor at Indiana State University, a licensed professional counselor in Indiana and Illinois, an approved clinical supervisor and a member of the ACA Gender Equity Taskforce. Contact her at Anna.Viviani@indstate.edu.

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

Hard at work

By Bethany Bray August 30, 2021

No employee clocks in to work each day entirely free from personal issues and struggles. However, individuals with mental illness face an extra layer of adversity in the workplace. Simply showing up and fulfilling job responsibilities can be an uphill battle for employees who are bombarded by intrusive, obsessive or critical thoughts; trauma flashbacks; depressive episodes; anxiety triggers; and other challenges.

Adding to the issue is the friction that can arise in a workplace when a mental illness — either disclosed or not — causes an employee to struggle to keep up with their workload or to take time off frequently to go to counseling appointments or tend to their mental health. Co-workers and supervisors can be unsupportive of a teammate who falls behind, sometimes regardless of whether they’re aware of the mental illness underlying their colleague’s work performance, making the situation worse.

Professional counselors can be key allies for clients whose mental health struggles are affecting — or even derailing — their work life. Being an ally includes providing support at an individual level, such as by equipping clients with coping mechanisms and talking through career-related decisions, and at a systemic level, such as by helping clients seek accommodations from an employer or otherwise advocate for themselves.

In these situations, a supportive counselor can normalize the client’s experience, help with perspective-setting and serve as a sounding board as the client talks through decisions and emotions related to work and career, says Meredith Montgomery, a supervising professional clinical counselor in Ohio and an assistant professor of counselor education at the University of Dayton. “It’s also a counselor’s role to know what different [mental health] diagnoses might bring up in a work setting. If a clinician is working with a client who meets the criteria for obsessive-compulsive disorder (OCD), you need to really do the research to know what that can potentially mean in the workplace. But at the same time, don’t buy into clichéd old ideas; look for the newest, updated information and laws that can help support them in a work environment,” says Montgomery, a member of the American Counseling Association. “Ultimately, a counselor’s job is one of support and illumination: to illuminate [a client’s] path, not to create the path, or determine the path, or push or pull them on the path, or shove them off of it, but to equip them with all the information you can to help them make their own decisions.”

A daily struggle

Behaviors that can indicate a client’s mental health is leading to problems in the workplace include frequent absences, tardiness, difficulty motivating themselves to perform their job, or job performance issues such as struggling to meet deadlines or other work expectations, says Amanda Hembree, a licensed professional counselor (LPC) and certified employee assistance professional with a private practice in New Orleans.

Perfectionism can also be a factor, she adds. For example, a client with OCD may miss deadlines or have trouble contributing to team projects because they need extra time to prepare and complete compulsive rituals or steps until an assignment is just right. This can especially be the case in job roles that involve safety, Hembree points out. Employees with OCD may feel they need to check and recheck their equipment, tools and other safety protocols repeatedly, causing them to be late or struggle to complete other tasks.

At the same time, Hembree acknowledges that many people with mental health challenges find “workarounds” to push through the workday and keep themselves from being noticed by co-workers or supervisors.

A client’s workplace challenges may also fly under the radar in counseling sessions unless the clinician fully explores how the person’s mental illness is manifesting across their life, Hembree stresses. Clients may seek counseling for a different presenting issue, such as parenting struggles or communication problems within a marriage, and fail to recognize or acknowledge that work problems can be a contributing factor to difficulties in their personal life.

“Don’t discount work,” Hembree urges her fellow counselors. “Clients are spending 40-plus hours there each week, and it will affect what they’re bringing into the counseling office. Work plays a big role in our lives, and you [the counselor] have to figure out the intersection of why they’re in your office and what is going on at work and what can be helped in both realms. None of us lives in a vacuum. Mental illness will affect every part of a whole person’s wellness — and especially work.”

Seth Hayden, an associate professor of counseling at Wake Forest University and president of the National Career Development Association, a division of ACA, also emphasizes the importance of listening for and asking clients about job-related challenges, regardless of whether their presenting concern involves work. A comprehensive client assessment should include questions about how their presenting concern manifests throughout their life, including their physical health, relationships, ability to engage in hobbies that interest them, and views on work.

If a client identifies work as a source of stress or discomfort, a counselor should explore that further in session, says Hayden, an ACA member who specializes in career transitions with military and veteran clients. This involves uncovering the thoughts and feelings the client associates with their job and how those things tie into the person’s self-concept and align with their core beliefs.

“If work continually comes up in their conversation, let’s stop there and dive deeper, talking more about the work that they do and how they feel about it,” says Hayden, a licensed clinical mental health counselor in North Carolina and an LPC in Virginia. “Have their feelings [about work] changed over time? Do an extensive examination of aspects of career and work and how [they’re] connected to other areas of life. … If you try to artificially separate them [mental health and career], it could potentially be to the detriment of the client … because they are interconnected.”

Asking the right questions

Avoidance behaviors and other signs of distress and unhappiness at work can result from any number or combination of sources, says Montgomery, who co-presented the session “Enhance Counseling Services by Integrating Clinical and Career Counseling Strategies” at ACA’s Virtual Conference Experience in April. She emphasizes the need for clinicians to fully unpack clients’ feelings and emotions about their work situation during counseling sessions.

Montgomery urges clinicians to draw on two foundational counseling skills: asking probing questions and using empathic reflection.

“We [counselors] need to make sure we are asking the right questions. We don’t necessarily want to jump on the ‘you hate your job, let’s get you out of there’ bandwagon. When you pull it apart, it could be a toxic environment, or … a bad fit, or they could make changes to make it a better fit, but often the only option clients see is to leave,” Montgomery says. “We need to explore, explore, explore, explore [the client’s situation] before we jump to any kind of solution formulation.”

When clients talk about how hard work is for them, counselors should use empathic reflection, repeating clients’ statements back to them, to allow them to think through these thoughts, Montgomery says. It may be a knee-jerk response to agree or sympathize with client statements such as “I hate my job” or “Work has been terrible since the COVID-19 pandemic,” but counselors must be careful not to inadvertently reinforce a client’s statement with their reactions, she advises.

Instead, clinicians can probe for details and ask clients to describe the feelings underneath the statements they are making. Montgomery finds that an emotion wheel can be helpful for prompting these conversations, so she suggests counselors keep copies handy in their offices or readily available for screen-sharing during telebehavioral health sessions.

Often, individuals do not fully express their experiences because they do not have the language to do so, Montgomery says. Using tools such as an emotion wheel is a way to increase a person’s ability to better understand and communicate their experience. For example, a client may initially say, “I feel angry at work.” But after looking at the emotions listed on the wheel, they may be able to better articulate their feelings by saying, “I feel underappreciated, exhausted and disrespected at work.” That deeper and clearer understanding is far more beneficial to both the client and the clinician because the solutions to feeling underappreciated are different than the solutions to feeling angry, Montgomery says.

This exploration stage of counseling should also include a focus on identifying clients’ needs and which needs are not being met through work or are being marginalized or curtailed in the workplace, Montgomery adds. For example, a client who is social and benefits from talking through challenges with others may feel isolated and struggle to process things or complete assignments if they’re in a setting where they work alone or are physically separated from colleagues by the office layout. Identifying these needs often provides clarity and helps clients move toward either making changes in their current job situation — such as asking to be moved to a shared workspace or scheduling regular check-ins with their boss — or considering a different position or career, Montgomery explains.

Montgomery first worked in the corporate and nonprofit spheres before switching to a career in counseling. She recalls her own process of adapting to a new role as a counselor educator. After some self-reflection, she realized she craved structure to navigate the varying demands of work as a university professor, and there were some ways she could ask for help and support in this realm from her employer.

Montgomery looked for tools to create structure, such as a whiteboard to make lists and keep notes in her workspace. She also suggested her department streamline processes by creating a master calendar with due dates for evaluations and other important benchmarks. Not only did this modification keep Montgomery from feeling like she was always behind, but several colleagues mentioned that they found it helpful too, she says.

Coping mechanisms

The interconnected nature of career and mental health may cause work-related discomfort to affect clients when they are off the clock. This can manifest in many ways, including sabotaging their ability to get to work on time in the mornings or channeling feelings of frustration or unhappiness toward family members after a frustrating workday.

Amanda Barnett, an LPC who specializes in mental health and work issues with clients at her private practice in Gainesville, Georgia, helps clients who struggle to separate work stressors from their personal lives to build intentionality into their routines. She suggests clients visualize changing “hats” as they transition to and from work. For example, a client may take off their accountant hat and put on their dad hat as they leave the office. For some professions, this transition is literal because employees change into work uniforms or wear a tool belt or other work equipment, notes Barnett, an ACA member. Regardless, she urges clients to take time to center themselves, give themselves a pep talk and be mindful about setting themselves up for the workday or for their return home.

Hembree notes that offering psychoeducation regarding how anxiety manifests in the body and providing tools to lower stress and anxiety in the moment can be particularly helpful with this client population. Breathing techniques can be a useful go-to tool in the workplace, especially because some of these techniques can be used without other people noticing, she says. Hembree, who has extensive experience working with clients through employee assistance programs, often teaches clients “box breathing,” which involves inhaling for four counts, holding for four counts and exhaling for four counts. This technique can be done discretely even when an employee is sitting in a work meeting or preparing for a presentation, she points out.

Another powerful yet simple tool is helping clients realize that they can take a break — even if just for a moment — when things begin to escalate at work. Many clients get so wrapped up in the emotions they feel when they are stressed that their instinct is to dive further into the situation rather than pull back for a moment.

“Unless you’re on a heart-transplant team, you can take five minutes to have a snack, take a break, meditate or do a grounding technique,” Hembree advises. “Even if your boss is breathing down your neck and saying, ‘I need this yesterday,’ you will do a lot better if you take a couple of minutes to ground … and center yourself — and your work will be better because of it.”

Hembree also finds techniques that counter negative self-talk to be helpful with this population. Clients who struggle in the workplace can easily fall into the “comparison trap,” she says. But as is the case when people compare themselves with others based only on what they see on social media, workers see only a portion of others’ lives at work. When a client is bombarded by negative self-talk, a co-worker’s success can send them further down that spiral. It’s easy to compare themselves and catastrophize, thinking that they’ll never be as good as their co-worker, that they are a failure, or that they are about to be fired, Hembree notes.

“Perhaps a co-worker gets praise from the boss. But what [the client] didn’t see is that [the co-worker] stayed up until 2 a.m. to finish [the work assignment], missed their kid’s soccer game, got in a fight with their partner and gave themselves an ulcer to get this modicum of praise from the boss,” she says. “A counselor can offer psychoeducation that others have good and bad days, and you will have a day when you’re the superstar.”

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Disclosure

The decision to disclose one’s mental illness in a work setting can lead to the good, the bad or the ugly. In a best-case scenario, an employer will respond to disclosure in a supportive and understanding way. Employees whose mental health challenges are affecting their work life can find support in an understanding ally — whether it’s a supervisor or a trusted co-worker — who knows the reason behind their work struggles. However, disclosure in a worst-case scenario can leave an employee open to direct or indirect hostility, misunderstanding, awkwardness, retribution or discrimination from an employer.

“There should be an element of dignity in work and being able to say things without any fear. But [counselors should] recognize that there are precarious elements of work that don’t make it easy for people to do that,” says Hayden, who presented “Career Development and Mental Health in the Context of COVID” at ACA’s Virtual Conference Experience. Hayden and the other counselors interviewed agree that disclosing one’s mental illness at work is a complicated issue that must be considered carefully depending on several factors, including how supportive the overall climate is at the client’s job.

Marina Williams, an LPC in Lexington, Virginia, who specializes in helping clients with work issues, stresses that clients should think carefully about what they have to gain by disclosing a mental illness in the workplace. This issue is even more complicated for clients whose work settings can involve direct or indirect repercussions if a worker is deemed unfit. Those in law enforcement, the military or jobs with a security clearance often feel particularly vulnerable about disclosing any type of mental health issue.

“Discrimination for mental health is very common,” says Williams, who presented on workplace bullying at ACA’s 2018 conference. “I recommend that clients not tell anyone [at work], but the exception to this is if they’re having such difficulty that they need to ask for accommodation in the workplace. But even then, I would limit [disclosure] to human resources.”

Hembree has also worked with clients who were treated differently after disclosing their mental illness in the workplace. She has heard clients talk about being treated like “fragile glass,” being denied job advancement or becoming the target of bullying behaviors such as being called a “snowflake.”

“It would be amazing if we lived in a post-stigma mental health world, but we are not there yet,” Hembree says. “I generally do not suggest that people disclose unless they are in a very supportive or progressive workplace.”

When the question of disclosing comes up in counseling sessions, Barnett encourages clients to think their situation through carefully. She cautions clients about oversharing and making the assumption that co-workers are friends. And she reminds her clients that the human resources department works for their employer, not for the employees. “Everything you say to human resources could go on your permanent record,” she tells clients. “Be aware that they have a duty to the company, not to you.”

Barnett once worked with a client who had mixed results after their boss learned about their mental health struggles. The client was having frequent panic attacks at work. Because the workplace was a closed, secure environment, the client couldn’t step outside easily or bring in personal items to help them cope.

The client’s boss became aware of the situation after a workplace incident triggered a panic attack and the client became visibly upset in front of him during the workday. After that, the client received what they termed “reluctant” support from their boss. The boss wasn’t cruel, but he wasn’t overly understanding either, Barnett recalls. The client’s stress also increased when the supervisor revealed that he was leaving and cautioned the employee that the next boss might not be as understanding to their situation as he had been.

What did help, however, were the coping mechanisms that the client learned and honed in counseling with Barnett, as well as a focus on quelling negative self-talk. Barnett and the client also found small ways that the client could stay mindful and calm during the workday, such as by chewing gum.

Clients who work on-site at a job may need to seek permission to leave for therapy appointments. They may also face questions or comments from co-workers about their frequent absences. If a client feels they need to explain their mental health struggles at work, a counselor can help them figure out a way to ask for leave without fully disclosing. For example, Williams says, the person could tell their boss, “I’m going through something right now, and these appointments are helping me.” It’s also OK to simply say, “I have an appointment” and leave it at that, she asserts.

Hembree agrees that disclosure can involve a range of information and doesn’t necessarily have to include details about a client’s diagnosis. She once counseled a client with attention-deficit/hyperactivity disorder who had trouble maintaining focus when he had to sit still for long periods of time such as in trainings or meetings. His solution was to stand and move periodically or ask for breaks with the simple explanation that he was feeling “fidgety.”

Counselors can ask clients how they feel about disclosing and how receptive their workplace might be to their mental health issues and to providing potential accommodations. Most of all, clients should disclose at a level that feels safe and comfortable to them, Hembree says.

“Everyone has to advocate for themselves, individually. That’s going to be different for every person,” she says. “For some, they are desperate to remove the stigma of mental health issues and wave that flag for everyone in their office and create a better environment for [all employees]. But that’s not for everyone. You don’t have to pick up that battle. You don’t have to be the spokesperson for depression [or another diagnosis]. You just have to do the best you can on any given day, and that may be disclosing and it might not be, or [it may be] disclosing in different ways.”

Accommodations

Employees may need to disclose a mental illness in the workplace if they are seeking accommodations that would help their situation. Possible work accommodations include being able to leave work regularly for therapy appointments, reducing an employee’s hours or responsibilities, or relocating from a cubicle to an enclosed office for increased privacy and decreased distraction, Williams notes.

Although the Americans with Disabilities Act (ADA) affords protections for workers, the language in the law guarantees “reasonable accommodation,” Williams points out. Counselors and clients should keep in mind that employers can make a counteroffer or refuse an employee’s request based on how reasonable they perceive it to be.

Hembree urges counselors who are unfamiliar with ADA or the protections it affords to seek continuing education on the topic, do research or consult with colleagues (including professionals in related fields such as human resources) to better support their clients. ADA also has an information hotline (ada.gov/infoline.htm) that counselors or clients can call to ask questions, she adds.

Hayden and Montgomery both suggest that counselors whose clients plan to disclose a mental illness or seek accommodations at work role-play in sessions to help clients gather their thoughts and prepare for the conversation. Hayden advises that it can be helpful for counselors and clients to explore the following questions:

What is the client hoping to gain from the conversation?

How might the conversation go? What do they anticipate happening?

What reaction might they receive? How will they respond to it?

Montgomery encourages clinicians not to make assumptions about a client’s comfort level regarding asking for things they need. Just because a client works in management or a position of authority doesn’t mean that they will easily be able to advocate for themselves, she says. Counselors should also never make assumptions based on the client’s level of education, socialization, cultural background or other factors, she adds.

“Assume everyone is terrified about asking for what they need and go from there,” Montgomery advises. “If we assume that no one is comfortable, then we don’t have to worry about offending someone or leaving someone unprepared because they’re uncomfortable asking you [their counselor] for help with learning how to ask.”

Hembree believes accommodations can be helpful for clients whose mental health struggles at work go beyond being a “nuisance” and truly interfere with their daily ability to do their job. As with disclosure, workplace accommodations — and the process to seek them — fall on a spectrum and will vary from client to client. Hembree says the documentation she has written for accommodation requests has ranged from in-depth reports for clients in government positions to a brief letter confirming that a client left work to see her for an appointment on a certain date and time. No matter the circumstance, she always has clients review the document to ensure they are comfortable with it before she submits it to their employer. She tries to focus her documentation on the client’s needs rather than the client’s problems, Hembree says.

Counselors can also work with clients to explore coping strategies that they can use on their own without having to seek an employer’s permission. In Hembree’s experience, clients have found it helpful to have fidget devices, noise-canceling headphones or calm strips (textured stickers a person can touch to soothe or ground themselves) at their desk. Customizing a workspace by adding plants or using a lamp rather than overhead florescent lighting can also be calming, she notes.

In other cases, employees can ask for measures that would help their situation without framing it as a mental health accommodation, Hembree says. For example, a client may notice that a different workspace is available in their office and ask to be moved without giving a reason.

Making work work

What is the tipping point between struggling at a job because of an underlying mental health challenge and foundering in a position that simply is not a good fit for someone with a client’s diagnosis? There’s no easy answer to that question, Williams says, but “keep soldiering through” is not a solution.

The counselors interviewed for this article agree that finding answers to this question should involve exploration of a client’s identity and how the client feels their job aligns with their identity and personal values. It can also be helpful to talk through the timeline of when a client started to struggle at work and whether that coincided with other events in their life, Williams notes.

Barnett suggests that counselors prompt clients to think about how long they’ve pictured themselves in their current role. For example, they could ask, “Have you always wanted to be in this career? Is it your life’s passion? Or is it simply a way to get dollars in your bank account?”

“You have to get to whether [the job] fits with the core of their identity,” Barnett says. Ask the client, “Is this what you really want to do? Is it your passion? Is it meeting your needs? If not, give yourself that freedom to make a choice.”

Counselors can also offer the perspective that clients don’t have to stay in a career simply because it’s what they studied in school or have been doing for years, Barnett notes. Clients can try out other careers by taking on a side job or working part time and slowly transitioning into another position if it is a good fit for them.

Above all, the client should guide the conversation, Montgomery adds. “Work, like relationships, can be a great source of purpose and meaning and can be a place where we can grow and do really exciting things and fulfill our brain’s desire for stimulation. It also can be a place where we get a paycheck, and we go home and we get all those things in other places [outside of work],” Montgomery says. “If getting purpose from work is really important to you and you want to do that, then make the decision that supports that result. But it’s also OK to just get paid and use that money to do fantastic things in other places. … We get all kinds of messaging that you should be saving the world through work. But the reality is that it’s not true for everyone. Everyone has different needs, and we just need to explore how to get those met.”

 

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

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

Working our way through a pandemic

By Laurie Meyers February 25, 2021

To appropriate a turn of phrase from Queen Elizabeth II, 2020 was our collective annus horribilis (horrible year). The queen was referring to 1992, a year that featured the implosion of three royal marriages, a devastatingly destructive fire at Windsor Castle, and unfortunate headlines involving Sarah Ferguson’s new beau and his, ahem, admiration of the Duchess of York’s feet.

But as the meme goes, 2020 said to 1992, “Hold my beer.”

The year that the queen “shall not look back upon with undiluted pleasure” included family losses, property destruction and embarrassing press. Stressful, to be sure, but ultimately personal and mundane (although, granted, most of us don’t have to face the paparazzi). But 2020 pelted us with events of a virtually seismic nature that have in one way or another affected billions of lives worldwide. The emergence of the novel coronavirus was not the only stressor or calamity the year visited upon us, but it remains arguably the most disruptive. And perhaps nowhere is that more apparent than in people’s work lives.

When the great shutdown began in the U.S. in March 2020, most of us thought we’d be confined to the house and working virtually for only a few months. But approximately one year later, and with more than 450,000 American deaths attributed to COVID-19 through the first week of February, many people are still hunched over their makeshift office equipment.

In the beginning, some of the work-from-home snafus were funny. Newscasters broadcasting with jackets — but no pants (which seems to be the preferred work-from-home style for a surprising number of people). The boss who accidentally turned herself into a potato on Microsoft Teams and didn’t know how to change back. Amusing, embarrassing and sometimes horrifying comments and conversations caught by accidentally unmuted microphones in video conferences. Other disruptions, such as cats on the keyboard and dogs chiming in during meetings, were a bit chaotic but too cute — at least at first — for their human companions to truly complain about. But other people struggled to carve out a workspace and found themselves joining meetings from underneath the stairs or barricaded behind the bathroom door because it was the only private space in a house full of busy (and noisy) family members. Even people who frequently telecommuted pre-pandemic often found adapting to an all-virtual workplace a challenge.

Balancing work, school and child care

One of the most significant challenges to working — whether virtually or on-site — during the COVID-19 era has been the lack of child care options and the need to assist children with their virtual schooling.

“Coaching folks on how to handle their work life without child care is a big focus of my practice these days,” says Katie Playfair, a licensed professional counselor (LPC) and management consultant located in Portland, Oregon.

“I tell clients to be as flexible and creative as they can in figuring out how to get their job done despite these obligations and to consider, when possible, cutting back hours to something more manageable,” she says. “As the mother of children who are 8, 6 and 2 years old, I home-school them during the day and then work from 5 p.m.-10 p.m. every evening after my spouse gets home. It’s a rough schedule.”

Playfair says many parents are having to take breaks to help with schoolwork during the day and then catching up on work themselves at night. Even children who are old enough not to need constant supervision often interrupt the workday to request a snack, to seek permission to take a break or to ask a quick homework question. As a result, parents are continually task-switching, unable to block out time for uninterrupted work, Playfair explains.

“Developing a system to communicate with older kids about when parents are interruptible and when they aren’t is vital,” she stresses. The use of physical or virtual calendars, door signs or predetermined “office hours” when they will be available to their children can help parents protect meeting times and allow for concentrated work during the day, she says.

“Providing kids with a way to table their questions until appropriate times is the other side of this equation,” Playfair continues. “They may need a whiteboard on parents’ doors or some other ways of tracking things so they don’t forget about them and get frustrated. Older kids can also be taught to email or text parents. Nonetheless, parents may still find themselves having to work nights or weekends to make up for the work that isn’t getting done during the school day.”

Even with families in which one spouse was already a stay-at-home parent before the pandemic, the virtual work and school mix can throw a wrench into the routine, says Keri Riggs, a Texas-based LPC whose specialties include relationship stressors, stress management and work-related issues. In one couple with whom Riggs worked, the mother was accustomed to structuring her day around the schedule of their middle school-age children. The family had managed to incorporate virtual school into their routine when, suddenly, the father began working remotely.

The only available workspace was the kitchen table, and the husband frequently needed everyone else to clear out of the room so he could participate in meetings. But he also recognized the need to give his wife a break — and the need to get away from the table himself — so they scheduled in lunches and other times when they would trade responsibility for the children. Because his meeting schedule varied, the couple sat down every night and plotted out the next day’s schedule, blocking off times when the kitchen needed to be in “do not disturb” mode and carving out time for breaks, says Riggs, a member of the American Counseling Association.

Fitting in the demands of work and school is even more difficult for single parents because, absent an available and willing relative or neighbor, there is no one to help shoulder their burden. Uninterrupted blocks of time may be available only when the children are asleep. However, some work-related tasks, such as meetings and phone calls, generally have to take place during the day. To help minimize disruptions, Jessi Eden Brown, an LPC whose specialties include trauma and workplace bullying, suggests parents buy or create “some kind of super-involved art project that they [children] only get to work on during meetings, so it’s kind of like a treat.”

“I don’t love this,” she continues, “but some clients have [also] had success with a television show or movie that can be started or stopped.” Brown, an ACA member, recognizes that isn’t an ideal solution, but it may be the only way that some clients can prevent interruptions in meetings. As she tells parents, with all the stressors they’re coping with, an extra hour or two of television here and there for their children is not the end of the world.

Of course, as Sharon Givens, an LPC who specializes in career development and mental health, points out, “Not everyone was able to just pick up a laptop and go home. If you’re a housekeeper, you can’t work from home.”

This is particularly problematic for single parents, she says. Some of her clients have family members who can assist with child care during the day, but others have had to relinquish their jobs. They are experiencing devastating financial difficulties that were exacerbated by the end of federally supplemented unemployment benefits.

“And, so, we’re working together to create some strategies to pay the rent,” says Givens, president-elect of the National Career Development Association, a division of ACA. Some clients have pulled money from their retirement accounts or tapped family members for financial assistance. Givens has also helped clients find local assistance programs and search for jobs that they can do from home.

The pandemic and resulting recession have demanded that counselors put on their “practical strategy hat” to help clients, Givens says. She has advised clients to speak with their mortgage company or landlord and their utility companies to see what type of deferment or other relief they can offer.

Setting boundaries and navigating distractions

The virtual office poses other challenges, such as the blurring of boundaries between work and home. By getting rid of the daily commute, office workers have gained extra time, but it has also deprived them of a natural boundary that signaled the beginning and end of the workday, Riggs says. The computer is always right there — a siren beckoning workers to check their email one last time or to do just a little more work. Suddenly, it’s midnight, and they’ve spent all day at the computer.

Riggs works with clients to replace the commute with other routines, asking what symbolizes starting and ending the workday for them. Is it taking a shower or changing out of their work clothes at the end of the day? She also suggests engaging in rituals such as hanging a “closed” sign on the computer or home office door or voicing a mantra such as “I did my best today.”

Sometimes, however, it isn’t employees who have trouble setting boundaries. American work culture is often brutal and not supportive of health and well-being, Playfair asserts.

“Unless an organization has set out to really change themselves into a more compassionate and empathetic place to work, they’re going to expect lots of hours, productivity and performance from everyone nearly all the time,” she says. “But even within this culture, there are opportunities for boundaries. First, I encourage people to ask their bosses, ‘Do you want the truth or what I think you want to hear?’ when an employee feels pressured past what they can take. Most people will choose the truth, and that will give the opportunity for healthy disclosure. I also like the phrase, ‘I wish I could do that for you, but I can’t because …’ to introduce a boundary.

“Finally, I think it’s helpful for employees to empathize with their bosses while still demanding support themselves. For example: ‘I understand that you’re short-staffed for this shift and that headquarters is expecting you to figure it out. That’s unfair. If our company would budget and plan sufficiently for contingency staffing, this wouldn’t be a problem for you or me, would it? I know they expect you to be fully staffed today, but they haven’t given you the resources to be successful with that, and I can’t personally make up for their poor planning.”

Brown encourages her clients to look for fellow employees who seem to be able to set boundaries. “Like ‘Bob’ — he always seems to sign off at 5. How does he do it?” she asks.

In other cases, Brown and the client may review their job description or the company’s policies and procedures manual to see if expectations for work hours have been set out.

Home itself can often be a distraction, Riggs notes. It can be difficult for people to focus exclusively on the work they are paid to do when they are surrounded by ever-present reminders of household tasks that also need to be completed, such as doing the laundry or loading the dishwasher. Cell phone pings announcing texts and social media notifications also beckon.

Riggs and her clients try out different solutions to find what works. This might involve setting a timer to complete 30-minute blocks of focused work, giving themselves a healthy reward for completing work, or setting up accountability partners. Riggs also suggests that, if possible, clients leave their cell phones in another room. If that isn’t feasible, she encourages clients to disable their notifications. She also counsels clients to prepare for the unexpected by allowing some margin for “white space” — a block of free, unscheduled time — during the day to attend to urgent requests or time-sensitive tasks.

The mental toll

Working under less than optimal conditions — or not working at all — has created significant challenges among a population that is already struggling with grief, Givens says. “All of us, if we’re being honest, are feeling a sense of loss: loss of activities, loss of career opportunities, loss of income.”

The uncertainty ushered in by the pandemic has challenged many clients’ coping skills, Givens says. She uses a variety of methods to help, including exploring what methods have supported clients’ ability to cope in the past. For some people, that involves more physical activity, whereas for others, it’s about increased (virtual) connection.

Givens also uses cognitive behavior therapy interventions such as having clients keep a thought record. They then look at this together and evaluate what is and what isn’t under the client’s control. “Many of them see the visual: ‘I spent four hours per day worrying about something that I couldn’t control,” she says.

Many of her clients are also engaging in frequent catastrophizing, obsessing about what will happen and whether they’re going to die in the pandemic. These concerns are natural, but some clients are mentally building worst-case scenarios, Givens notes. For these clients, she uses a different kind of thought record known as an evidence record. The concept is the same — clients write down their thoughts and then go over them with Givens — but what they’re looking for is any evidence to support the likelihood of their worst-case scenarios becoming reality.

All of the practitioners Counseling Today spoke to for this article urge clients to be patient with themselves as they navigate the myriad challenges of working during the COVID-19 era. Riggs recommends Kristin Neff’s five-minute self-compassion break (a guided version is available at self-compassion.org/guided-self-compassion-meditations-mp3-2/).

The practice begins by, as Neff puts it, “calling up a little suffering,” or reflecting on something that is currently causing stress or worry. Neff then provides a series of phrases “designed to help us remember the three components of self-compassion when we need it most.”

The first phrase is “This is a moment of suffering.” Or, as Riggs tells her clients, “I’m having a hard time today. I’m struggling.”

The second phrase is “Suffering is a part of life.” Riggs describes this as recognizing one’s connection to all of humanity: Not only am I struggling, other people struggle too. I am not alone.

The third phrase is “May I be kind to myself in this moment.” To support being kind to oneself, Neff suggests that listeners place their hand over their heart or another place on their body that feels soothing, then focus on the warmth of their hand and let that sensation stream through their fingers. She then recommends that listeners direct kind and supportive language toward themselves, such as words they might use with a friend going through a similar situation — e.g., “I’m here for you. It’s going to be OK.”

At the end of the practice or “break,” Neff asks listeners to notice how their bodies feel and to allow themselves to just “be” in the moment with those sensations.      

Riggs also suggests clients ask themselves what would make them feel better at that moment. “That’s really the hardest piece if you don’t know what you need,” she says. “Do I need to move my body? Do I need to journal? Call my best friend? Put on music? Give myself a hug?”

Finally, Riggs tells clients to remind themselves that the stress or anxiety they are currently experiencing will not last forever — that they won’t feel like this forever. Eventually, it will change.

Amid the suffering caused by the pandemic, Brown sees opportunities for personal growth. “Never before have we had … [such a] profound opportunity to slow down and focus on life’s priorities with such intention,” she says. “COVID-19 has affected nearly every person on the planet. Countless people live in fear, and many have lost family, friends, livelihoods and so much more.

“The tragedy is undeniable. That said, I have always believed that low moments like these potentially set the stage for meaningful change as we reflect on what is important and how our decisions either support or impede our progress.”

 

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The pandemic and a frayed political climate have also been at the center of various instances of workplace bullying. Read more in our online exclusive article, “No rest for the bullied.”

 

 

 

 

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

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

No rest for the bullied

By Laurie Meyers February 1, 2021

The climate of intolerance, anger and, to put it plainly, hate, that was encouraged to bloom during the past four years have kept Jessi Eden Brown busy as the professional coach for the Workplace Bullying Institute (WBI) and in her private psychotherapy practice in Seattle. According to the WBI, targets of workplace bullying consistently reported more frequent and more brazen attacks, crippling sabotage, and mobbing based on known or assumed opposition to the Trump administration. Brown has seen this trend playout in her private practice and in her coaching work at the WBI. In the weeks surrounding the insurgent attack at the U.S. Capitol, two of Brown’s clients reported that workplace harassment had escalated to personal property damage.

“One had, ‘Trump 2020,’ scratched into the hood of his car in the employee parking garage,” says Brown, a licensed professional counselor. “And the other told me his locker was broken into [and] the contents [were] soaked in red paint, one day after the U.S. Capitol riot.”

The division between mask-wearers and anti-maskers during the pandemic has also created a pernicious type of bullying, Brown says. “For example, one client told me that three workplace bullies have ‘fake coughed’ in her direction for months, often followed by snickering and occasional obscene gestures. She said she considered reporting the problem to HR or management, but her last grievance resulted in retaliation, so she has opted to try to ignore it and keep wearing a mask.”

The pandemic has also contributed to an uptick in bullying in other ways, Brown says. “At the beginning of the pandemic, many of my clients reported an overwhelming sense of relief as they transitioned to remote work [and were] no longer required to face their bullies in person,” she explains. “Bullying tactics such as micromanaging, nonverbal intimidation and public humiliation were dampened by distance. However, for some clients, that period of calm was short-lived, as bullies began to weaponize the very technology we rely on to work from home. Clients told me their invitations to essential Zoom meetings were ‘somehow overlooked.’ They talked about the relative ease with which bullies manipulate reports and documents, craftily overinflating their contributions and minimizing the target’s value.”

Brown’s clients have also reported feelings of mounting isolation as they face increasing levels of resource gatekeeping.

The economic collapse brought on by the pandemic is also being wielded as a weapon, according to Brown. One client’s boss regularly makes threats such as “This is not the time to be jobless, so you really don’t want to screw up next week’s presentation.”

Brown says that, understandably, most of her bullied clients fear leaving their jobs during the pandemic, despite the abuse they are subjected to.

“Sometimes there are ways to push back and advocate for yourself; other times that may only make things worse,” she says, noting that the outcome is highly situationally dependent. “I work with my clients to explore their options and refocus whenever possible on addressing their health. Setting boundaries, boosting self-care and seeking outlets for processing pain and frustration — all might help the client survive in the job until the outlook is more positive.”

“A couple of my clients have reached their absolute limits in dealing with workplace aggressors and have opted to resign, transfer or prematurely retire despite the extraordinary uncertainty of a global pandemic,” Brown continues. “One client is taking advantage of the opportunity to return to school and recast her career in a different direction. The other is taking a bit of time off, living on savings and repairing his health — knowing he has a financial cushion of exactly six months. As that deadline draws near, we will plan out the next steps and, ideally, he will reenter the workforce feeling a bit recharged and focused on creating a fresh start.”

These are difficult situations to face in counseling, Brown acknowledges, and she sometimes becomes concerned for the safety of her clients. “First, I listen to their account of the incident, allowing the client to process the fear, anger, confusion and vulnerability that comes with being persecuted,” she says. “From there, we talk about any steps — minor as they may be — to help the client feel safer.”

For example, because his house keys and wallet were in the locker when someone broke into it, Brown’s client decided to change all of his locks at home and add two more security cameras to his home system.

In cases that involve bullying that is potentially criminal, Brown and her clients discuss whether to file a police report or take any other formal action, weighing the costs and benefits of these decisions.

“I also research and pass along any specific resources that might offer additional support for my client, such as hate crime victim support groups, PTSD [posttraumatic stress disorder] groups … Unfortunately,” she says, “as things continue to deteriorate in our society, it is challenging to help these individuals fully regain a sense of safety, which is something we often recognize and address openly.”

“I have witnessed the combined effects of a divisive Trump administration, a deadly global pandemic and an intense racial reckoning precipitate enduring traumatic injuries on some of my clients. Often,” Brown concludes, “I think the repair and healing work we do in therapy is only just beginning, and even more challenging times lie ahead.”

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COVID-19 has largely redefined where people work, how people work and the workplace challenges that confront employees as they try to make ends meet. Read more in the article “Working our way through the pandemic,” in the March 2021 issue of Counseling Today.

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

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

Putting first responders’ mental health on the front lines

By Lindsey Phillips July 6, 2020

A firefighter/emergency medical technician (EMT) in Maine answers an emergency call. He grabs his gear and performs a job he knows well. The next day, he discovers that the person he helped has tested positive for COVID-19. He immediately starts worrying not just about himself but about his wife and young child, who have respiratory issues.

Amy Davenport Dakin, a licensed clinical professional counselor in Maine and a licensed clinical mental health counselor in New Hampshire, has been working with this firefighter/EMT for several years now. Before this incident, he had struggled with anxiety, depression, suicidality and posttraumatic stress disorder (PTSD), but with Dakin’s help, had successfully worked through many of these issues. This latest experience of being exposed to the virus that causes COVID-19 adds another layer of stress and anxiety that could negate his previous progress, Dakin says.

As the name implies, first responders such as EMTs, police officers, firefighters, paramedics, dispatchers and others are trained professionals who are the first to respond in emergency situations. Unless people happen to be facing an emergency themselves, this service often gets taken for granted, and little thought is generally paid to the accumulating toll on first responders’ mental health.

That calls for a reality check. “Our worst day is first responders’ every day,” points out Drew Prochniak, a licensed professional counselor (LPC) and licensed mental health counselor (LMHC) in private practice in Portland, Oregon. “Their days are filled with accidents, pain, grief, loss and trauma.”

According to a 2018 supplemental research bulletin from the Substance Abuse and Mental Health Services Administration’s Disaster Technical Assistance Center, depression and PTSD affect approximately 30% of first responders. In addition, 37% of fire and emergency medical services professionals have contemplated suicide, which is nearly 10 times the rate of American adults in general. In fact, in the United States, more firefighters die from suicide than from fires, Dakin notes.

It is easy to surmise that this population could benefit from therapeutic interventions, yet its members are often the last to ask for help. By getting to know the first responder community and tailoring approaches to match this population, counselors can break down some of the barriers that prevent these heroes from prioritizing their mental health.

Getting to know the culture

Dakin, a member of the American Counseling Association, acknowledges that it can be difficult for counselors who do not have previous experience with first responders to get a foot in the door with the community. Someone initially referred a firefighter to Dakin for counseling services, and the experience piqued her interest in working more with first responders. But first she had to earn their trust.

For approximately seven years, she attended labor union meetings, conducted trainings and presentations, rode along with first responders on calls, and hung out at their stations. This exposure allowed her to build relationships and trust within the first responder community and helped her determine that it was a population with which she wanted to work full time. Today she owns New Perceptions Inc. in Kingston, New Hampshire, a private practice that focuses on trauma and mental help treatment for first responders.

Prochniak, a former search and rescue professional and author of the book Addiction & Recovery for First Responders, agrees that establishing a relationship with a first responder department or agency is an important step toward overcoming community members’ belief that clinicians don’t understand their culture. “There’s this mystique about clinicians that we only want to talk about emotions and get in people’s heads,” Prochniak says. Building relationships with first responders outside of counseling sessions will show them that therapists are just regular people too, he says.

Prochniak, who specializes in the education, training and treatment of first responders, says there is a personality type that goes along with being a clinician who works with this population. Counselors must be able to handle hearing about grotesque experiences and communicate respect for the work that first responders do, he explains. With clients in law enforcement, this often means that counselors must be comfortable with clients having guns in session, he adds.

Prochniak cautions counselors against asking first responders about the worst thing they have seen, what type of gun they carry or whether they have ever shot someone. Instead, counselors should be curious about them as people: How long have they done this work? What led them to get into this line of work? How does their work affect their family? What kind of social network do they have? Do they hang out only with people from the first responder community? What else do they do outside of work?

Counselors will also need to be able to tolerate a dark, almost morbid, sense of humor because first responders often use that as a coping mechanism. “One of the ways we cope with trauma is with humor. And it can be really upsetting for people who don’t experience [what first responders do],” notes Carrie Whittaker, an LPC and LMHC in New York and Connecticut.

Prochniak points out that counselors must also be savvy about managing dual relationships. In addition to being a clinician in private practice, he is also a trainer and educator. At the start of every new client relationship with a first responder, he prepares them for the possibility of also bumping into him at trainings, briefings, meetings or ride-alongs. He makes it clear to these clients that he will not initiate acknowledgment of them in such circumstances out of respect for their confidentiality. “One wrong slip in acknowledging that you see someone [in counseling] or that you know someone else could cost you a client,” he explains.

In addition, counselors have to be flexible when working with first responders because they have irregular schedules, Dakin says. This might mean needing to conduct telehealth sessions or meeting with these clients outside of the typical 9-to-5 workday. There will also be last-minute cancellations, she points out. Dakin typically has a 24-hour cancellation fee, but she waives it for first responders who are stuck at work or otherwise have a good reason for not making their appointments.

In many ways, counselors may need to be on call themselves when working with first responders, Dakin says. When there is an emergency such as a line-of-duty death or an explosion, Dakin has to be prepared to drop everything, including her current caseload for that day, to respond. And if a client who is a first responder has a bad call on a Sunday, then she is also working that Sunday. Although it has happened infrequently, she has even had the labor union or clients call her as late as 10 p.m. because of an emergency.

Prochniak and Dakin both emphasize the importance of being humble when working with this population. “Although you are the professional in mental health, you’re not the professional in their field,” Prochniak explains. “Just because you know trauma or just because you know stress doesn’t mean you know this population. It shows up very differently … because this is a unique culture. So, get to know the culture. Spend time with them.”

No shame in needing help

The biggest barrier to first responders seeking help is the attached stigma — a false belief that if they need counseling, it means they are weak or unfit to do the job, Dakin says.

People often assume that because first responders signed up for the job, it means they are prepared to handle the associated trauma. But that’s not how the brain works, Dakin stresses. “The brain can only handle so much exposure to traumatic images before it’s on overload,” she says.

Joel Smith, an LPC in private practice in Denver, concurs that as a society, we do relatively little to acknowledge vicarious trauma among first responders. Although these professionals do generally possess an enhanced skill set to cope with trauma, they are still vulnerable to burnout, he says. Smith tries to normalize this reality for clients who are first responders by asking, “Has your stress been building up for a while? Is it exploding? How are you handling your stress?”

Whittaker, an ACA member who has a private practice in Manhattan and Westchester, New York, puts this idea of “being tough enough to handle it” into context for her first responder clients. She explains that being tough doesn’t mean that they never get upset or that nothing bothers them. It means processing those feelings to help themselves do their job better.

“It’s important for counselors to remind them that being tough enough to handle it doesn’t have to mean being hardened to it. It doesn’t mean that you don’t break down and cry sometimes,” she says.

First responders also have a tendency to not want to burden others with what they have experienced. Some of Dakin’s clients have said to her, “It’s a really bad call, and I don’t know if I want to put those thoughts in your head.”

Clinicians have to reassure these clients that counseling is a safe space for them to talk about their issues and experiences. When hearing difficult stories, Dakin says, counselors should refrain from sounding alarmed and making statements such as, “I can’t believe that happened! That must have been horrible.”

“While [that statement] is validating and has the best of intentions, that’s not what these people want to hear,” Dakin says. “They basically want to talk. They want to tell their story.” Counselors can validate that the client’s experience was tough without being too reactionary, she says, and that largely involves listening carefully.

Counselors should also remain aware of their facial expressions, Whittaker adds. If counselors look shocked or terrified, these clients will notice and be more likely to shut down.   

Smith, a therapist at Jefferson Center (a community-focused mental health care and substance use services provider in Colorado) and an associate at Look Inside Counseling, finds motivational interviewing an effective technique when first responders are hesitant to accept help from others. For example, Smith says, counselors can ask these clients, “How can you receive help yourself?” or “How can you model receiving help?” The technique allows first responders to develop some healthy discomfort with the fact that they are simultaneously heroes who help others and people who need help with their own problems, Smith explains.

“One of the best ways they can help themselves is to feel like they have a role in helping someone else,” Smith continues. That’s one of the reasons he encourages first responders who have benefited from counseling to tell colleagues about how it has helped them.

These clients could share an effective coping skill they learned in counseling with the rest of their team, or they could model self-care at work. “If you see someone struggle, that’s one thing. But if you see them struggle and overcome it, it builds the idea that it’s possible [for you too],” Smith notes.

Tailoring counseling to fit first responders

Prochniak, the mental health professional for American Medical Response in the Portland/Vancouver metro areas, finds that mindfulness, focused breathing and meditation techniques all work well to reduce first responders’ anxiety and stress levels and build their stress resilience. Sometimes, however, these clients can be hesitant to try such techniques, either because they perceive some stigma attached to the techniques or because of the way that counselors present them.

One approach that can help break through this hesitation is finding concrete ways of translating clinical speech into first responders’ everyday language, Prochniak says. For example, if he’s working with a paramedic, he will discuss how mindfulness techniques strengthen the parasympathetic nervous system. If he’s working with a client in law enforcement, he will reference combat breathing, which is how these professionals already describe the use of deep breaths to calm down or reduce stress.

Dakin frequently convinces first responders to give mindfulness and yoga a try by explaining the science behind the exercises. She often compares how the brain processes trauma with what happens with diabetes: Just as elevated levels of glucose in the body worsen when the pancreas does not work correctly, experiencing too much trauma causes an overload of chemicals to be dumped into the brain. Then the brain responds by releasing cortisol. Breathing and mindfulness exercises help reduce that response and regulate chemical levels.

Similarly, the traditional way of presenting and explaining yoga doesn’t match with the culture of first responders, Dakin notes. When she first encourages these clients to try yoga, the response is typically along the lines of, “I’m not going into a studio wearing spandex and meditating.”

To counter this negative perception, Dakin recommends a yoga program designed specifically for first responders (yogaforfirstresponders.org). The program gears its language to fit the culture, she says. For example, it renames child’s pose as a warrior’s pose, which is a more strength-based term. Dakin now knows some first responders who practice yoga on the job to regulate their breathing and avoid going into fight-or-flight mode as quickly.

Smith has discovered that some of his clients find it helpful to conceptualize grounding techniques as a workout. They have a “grounding buddy,” and together they work on their awareness, he says.

Dakin also uses familiar language to help first responders get more comfortable with mindfulness. For example, rather than having firefighters use a numerical scale to describe how upset they are, she uses the fire danger warning scale, which estimates the existing and expected fire risk for an area. The scale is color-coded, moving from red (extreme danger) to green (low danger).

If a client says they are in the red, then Dakin has them breathe deeply while imagining their arrow moving into a safer level. She explains how each breath is calming their nervous system. This skill has become a special language that she shares with her clients. A client may start a session by saying, “I was in the red a couple of times this week, but I breathed and at least got myself into the yellow.”

Dakin also explains to clients that mindfulness doesn’t have to be limited to sitting still and taking deep breaths. It can take the form of something they normally enjoy doing, such as fishing, taking a walk, kayaking or hiking, as long as they are doing it mindfully.

Managing anxiety

First responders often get anxious anticipating what their day might hold. “Schedule and routine are the enemy of anxiety,” says Smith, who specializes in trauma, mood management, addiction, and LGBTQ-specific needs. First responders can incorporate comforting activities such as walking their dog or calling a family member at certain times throughout the day. “Having that kind of expectation in life leaves less room for anxiety to happen,” he explains.

He encourages his clients to make grounding a part of their daily routine. They can ground themselves when they wake up, when they shower or when they go to bed. They can also ground themselves on the way to work, Smith points out, taking a few minutes when they are at a red light and noticing what’s happening around them: “I’m stuck in traffic. A kid is riding a bike beside me. It’s raining. A song I like is playing on the radio.”

Smith advises clients to set phone reminders to ground themselves. Even if they can’t check their phones that minute, they will be reminded later. Then they can take two minutes before going back to work to breathe and be aware of the way their body feels, their surroundings and their emotions.

Grounding can also be a preventive measure, Smith adds. “If you walk into an emergency and you’re already grounded, then you’ll be better off on the back end of that emergency,” he says.

As clients progress with their grounding skills, Smith asks them to visualize grounding themselves during an emergency on the job. This involves visualizing the person in front of them who is having the emergency, as well as all the chaos and turmoil unfolding around them, while also being aware of their body and their role in the situation.

“It sounds counterintuitive to have them visualize chaos, but first responders are going to experience that during their day, and then they can ground themselves in the midst of this chaos,” Smith says. This is an advanced grounding skill and not appropriate for first responders who have just started therapy, he points out.

Processing the trauma

Trauma is no stranger to first responders. They see people die and watch people suffer, all while working long hours. And they often feel unable or powerless to help, Smith says.

Some first responders also wrestle with guilt over choices they made during an emergency. “When you have to make a decision in a split second, that’s something that can be really haunting. It might mean saving your life or saving someone else’s life but sacrificing something or someone else,” says Whittaker, who specializes in working with trauma.

“Trauma makes us think horrible things about ourselves and our own abilities,” Smith says. For example, a highly skilled emergency room nurse may suddenly doubt their skills if multiple people die during their shift one week. The nurse may suddenly feel out of control or useless.

Smith finds trauma-processing therapies such as eye movement desensitization and reprocessing (EMDR) and trauma-focused cognitive behavior therapy effective with the first responder population. These therapies help clients process their feelings about the trauma while learning to separate themselves from unhealthy thinking.

Because emergency situations are filled with chaos and unpredictability, it is often difficult for first responders to slow down and think about what they can realistically control, Smith says. He often has clients journal about what they can and can’t control.

“They can have control over their own beliefs about themselves and what their own purpose is. And that can be enormously helpful in a trauma environment,” Smith says. With EMDR, clients are able to look at a task that gives them anxiety, reduce that anxiety, and feel more confident to perform that task, he adds.

Behavior patterns can be telling

Dakin often detects PTSD and emotional problems by looking for behavioral shifts or irregular behavior patterns with first responders. For example, a first responder who has been working in the department for 20 years without any issues may suddenly start yelling at the fire chief and refusing to follow rules. When this happens, the labor union often asks Dakin to perform an evaluation to figure out what might be going on.

Counselors should also be aware of behavior patterns around substance use. “There’s a huge co-occurrence of substance abuse and trauma,” Smith says. “So, if you work in an environment where you’re going to see and experience trauma, then … you’re more likely to develop a substance abuse problem.”

First responders might not necessarily be battling a long-term addiction or engaging in binge drinking, Prochniak says. They might just be spending their days off work each week casually drinking because they find their home life less exciting than their work life, he observes.

Both Prochniak and Smith encourage counselors working with first responders to ask about their substance use, including amount, frequency and any changes over time. “If that problem exists, then it’s usually helpful to manage substance abuse habits before working on trauma,” Smith advises.

Prochniak also encourages clients to notice when they experience the itch to have a drink or use drugs and to think about what that itch (the substance use) is trying to scratch. Are they anxious, bored, unsettled? Together, they then figure out a plan to address the underlying issue. “Breaking it down into this smaller view of what’s behind the drinking [or substance use] can be helpful,” he notes.

Developing transition plans

All the stress and trauma of the job can spill into first responders’ personal relationships. “People who are going through trauma can be emotionally up and down, so a first responder may be angry or irritable, if not explosive, sometimes,” Smith says. “Maybe they will cry a lot or be super anxious and not be able to really be in a room with [family or friends] because they have pent-up energy.”

First responders often need help learning how to transition from work to home, where the rules may be different, Prochniak says. For example, if a firefighter works a 24-hour shift (followed by 48 hours off), their partner is in charge of the house for those 24 hours. When the firefighter returns home, they may be upset because they expect the house to be clean and organized like it is at work.

Prochniak and Smith help these clients develop transition plans to better manage the boundaries between work and home. Smith encourages his clients to perform self-checks before heading home from work. They can ask themselves, “Where am I right now? How am I feeling (angry, sad, anxious)? What do I need before I go home?” His clients often discover they need to take 30 minutes for themselves. They may go for a run, sit in the car and listen to music, read a book or grab a bite to eat before they are ready to take on the demands at home.

Prochniak recommends that first responders use the following transition strategies:

  • If they’ve had a rough day at work, text or call their partner to provide a heads-up.
  • Take 30 minutes to exercise either at a gym or on equipment they keep in their garage to process the cortisol and neurotransmitters that have accumulated over the course of their shift.
  • Change their clothes at work so that they don’t wear their uniform home. Prochniak often advises clients to look at the shoes they’re wearing. If they are wearing their duty or work boots, then they are at work. If not, then they are at home. This serves as a reminder of the role they are in and what their expectations should be.

Helping first responders support themselves

First responders operate in a close-knit community. “They protect each other, but they also don’t know what to do [to help one another],” Dakin says. She recalls a client who found his co-worker’s behavior troubling, but he wasn’t sure how to provide assistance because he didn’t want to get his friend in trouble or for his friend to get mad at him.

One of the best things counselors can do to support this population is to educate them on healthy ways to help one another. Dakin works with a program (offered by the International Association of Firefighters and the Professional Firefighters of Maine) that trains firefighters to look for warning signs that a co-worker may be struggling and to intervene before it turns into a mental health crisis.

According to Whittaker, peer support often works better than group therapy for this population. Group therapy places people who have been taught to swallow their feelings and just “deal with it” in a setting where they may fear what a therapist will push them to say and how their peers will react, she explains.

Peer support, on the other hand, “takes the therapist out of the room,” Whittaker says. “It is led by people who have been through it and people who can find that common ground. It feels less like therapy and more like people just hanging out and talking, which is a much safer experience for them.”

Dakin recently helped some firefighters/EMTs launch a peer support recovery group. Even if she is present in the group, she lets the first responders lead. She is there not as a counselor but as moral support, she says. If the group asks for her clinical advice, she provides a quick blurb on how the brain works or offers tips such as how to get better sleep. She then fades into the background and lets the group take control again. The goal, she says, is for the first responders to support one another.

Responding during COVID-19

The “invisible threat” of COVID-19 currently looms over first responders, Prochniak says. When they pull up on scene or respond to a call, they no longer know what to expect. They have to assume that everyone is sick or symptomatic, so they wear protective gear and practice physical distancing as best they can while still performing their jobs.

Clients have told Prochniak that although the number of emergency calls has decreased, the overall intensity of those calls has increased. More calls have been made related to suicide and domestic violence.

Most first responders are anxious about what the future holds, Dakin says. They worry about the health of their families and co-workers and their own health. They are concerned about people in the community who often rely on their services and who aren’t calling right now. And they are anxious about the types of calls they will receive once call volumes return to normal.

Prochniak is helping his first responder clients manage their anxiety over the COVID-19 pandemic by having them focus on what is in their control. They may not be able to reduce their threat of being exposed to the virus, but they can develop a plan for what they would do should they be exposed. Would they live in the garage, in a tent in the backyard, in a hotel? How would they handle child care?

Whittaker admits that listening to first responders’ experiences can be difficult, but she also appreciates that they are willing to share something so personal with her. She makes a point of ending each session on an uplifting note. They might talk about how the client demonstrated bravery, how much the client has improved at using a particular counseling skill or how an experience worked out better than the client expected.

“When you see change in somebody’s life,” Whittaker says, “it’s easier to hear these difficult stories because you have a role in making it a little better for them.”

 

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

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