The coronavirus pandemic has severely restricted social gatherings, travel plans, and in-person events for most of 2020. And that has created a confusing scenario for counselors and other mental health professionals: When almost everyone is physically isolated from some extent – and will be for the foreseeable future – how do you realize that a client may be isolated in the "classical" sense of what is usually called red flag is seen as someone struggling with their mental health?
Nixon, like many clinicians, has had to change and react differently to the way he thinks about what isolation is like for clients during the COVID-19 pandemic. When screening for isolation and depression, one of the main indicators counselors look for is a loss of interest or a lack of participation in activities that a person has once enjoyed. However, during the pandemic, many customers have not felt safe engaging in group sports or participating in activities or hobbies that others are usually involved in. Also, many of these activities were not available anyway due to widespread cancellations and closings. "As I've gone through the past six months, my view of what isolation looks like has definitely changed," said Sean Nixon, a licensed clinician professional counselor outside of Boise, Idaho who works with children and families. “I used to think of isolating myself as a person who was alone, not engaged to be engaged, or not interacting with anyone. But now, [for] a lot of the people I have worked with in my practice, there is this forced, constant isolation. Even now that they can get out of the house, walking up to someone and hugging them like you might have done six months ago is not the norm. "
“Now when I ask these screener questions, I have to consider the person's situation. … We need to investigate more – are we seeing an increase in depression, an increase in stress due to the pandemic, or are we dealing with both? “Says Nixon, a member of the American Counseling Association who works as a pediatric psychotherapist in an outpatient setting for a medical system.
Nixon says he also broadened his thinking about isolation to look for it in both individuals and entire family units. Not only do families feel isolated from friends and off-home activities that they used to enjoy, but they sometimes isolate themselves from each other within the household during this stressful time, he explains. This can range from physical withdrawal like closing the bedroom to spending too much time using digital devices as an avoidance mechanism.
Signs of isolation in families with children are often evident when adolescents express a constant desire to play with a caregiver or to do individual activities with them, he says. At the same time, many parents express that they feel overwhelmed or feel guilty about having to take time away from their children when they are working from home.
“I hear from the parents [in sessions] how they just need a break and have the feeling that their children always want their attention. They try to strike a balance while still having work responsibilities, trying to explain to younger children that “Mom and Dad aren't just at home; We're home with work to do. "It's definitely a burden and a struggle for parents," says Nixon, who is also a licensed marriage and family counselor.
"The previous concept of isolation was often an individual problem," he continues. “But [as the pandemic worsened] I was working with family units that were limited in size, and I noticed the stress and overwhelming emotions associated with being together 24 hours a day, seven days a week. As this increased, it helped some families grow closer together. For others, it was an increase in their dysfunction and a more rapid rupture. "
What to listen to
Ryan Holliman is a Licensed Professional Counselor and Supervisor (LPC-S) and Counseling Educator who counsels adult clients one day per week at a free medical clinic in Dallas. It's always important for clinicians to build strong bonds with clients and figure out what's normal for them and what's not, but that's even more the case now, he says.
Many of Holliman's customers suffer from personality disorders and have difficulty maintaining long-term relationships. During the COVID-19 pandemic, Holliman has found the need to screen clients for isolation more regularly and more rigorously, including targeted questions about their relationships and the resources they rely on when they are stressed.
"The isolation is much more nuanced now," says Holliman, ACA member and assistant professor at Tarleton State University. “You have to listen to different things [such as] when you proactively develop and access social networks, or do you let COVID-19 determine the conditions of your social life? … Most relationships are currently under a lot of stress. [because] We put the entire emotional weight on a few places. "
Holliman increased its check-ins with customers about their relationships with friends and family and asked them to rate those relationships on a scale. He asks, "How happy are you with the relationship and how happy is the other person with the relationship?" The goal of this exercise is to ensure that customers keep growing in their relationships and not stalling during this difficult time, he explains.
"With COVID-19, it's easy [for clients] to say," good enough is good enough "and indulge in complacency. But I tell customers," I don't want this for you. "It is easy to say: "It's a crisis, it's a pandemic, and that's as good as it gets." But as advisors we are called to be dealers in hope, "he emphasizes." Help yourself [clients] To turn to hope and [see] that there can be more. "
In the student population, many people exhibit typical signs, such as insomnia or being overwhelmed, which suggest they are having problems and feeling isolated – but exponentially, says Elizabeth Bambacus, student and summer studies administrator at Virginia Commonwealth University (VCU) . She runs a peer mentoring program for first generation college students, a population already prone to feeling out of place and having self-doubt. Their program connects first-generation freshmen with upper-class freshmen for support, guidance and friendship.
According to Bambacus, many of her students have spoken about their academic programs being much more difficult this fall. A college student recently noted that she wouldn't be upset if she tossed her laptop across the room and it broke. In another conversation, a male student told Bambacus that he had not been outdoors for four days.
"We [would] generally have students stopping by in [to our office] and saying hello and random drop-ins who want to chat about anything from 'I'm worried about a task' to ' I just had a big argument with my dad and it is affecting my ability to concentrate. "But there is not much opportunity for that now," says Bambacus, who has a doctorate in consultant training and supervision. "It's just not the same because everyone eschews everyone."
The Richmond VCU campus is open, but the majority of school classes are online. While some students stay on campus, many have chosen to live at home or alone in off-campus apartments, says Bambacus. Most of the ways students usually interact in person with others, from going after class to ask a professor a question to attending student clubs and group events, are off the table this fall.
Another important indicator of student isolation is avoidance behavior, e.g. B. not getting in touch with peer mentors and neglecting tasks or letting their academics slip in other ways. Bambacus notes that many students, including those who have responded in the past, won't reply to their emails this semester. "College students are generally not very good at it," she says, "but I've noticed an increase."
Many students are also experiencing a resurgence this year from anxiety and depression that were previously under control, adds Bambacus. Students with these diagnoses are always at risk of isolating behaviors, but this year it is acute. When they feel separated, their fear increases and they get back into their class work, which creates a vicious circle, she notes.
"I see that students are overwhelmed, lag behind in class, and that also triggers – this feeling of doom." Oh no. It happens again. "How can someone be with all the fears and depressive thoughts Doing homework or studying for a test? It takes so much mental energy, and the shame of not being able to – beating yourself up for not being able to concentrate for more than 30 seconds at a time – is just a cycle. "
Adjust as necessary
Holliman not only gets in touch with customers more often and listens to the different (and possibly new) ways isolation affects them, but also focuses on self-talk. In the past few months, many clients have been exposed to a downward spiral of self-critical thinking, he says.
Many of his customers talk about "getting stuck in their own thoughts," he notes. "If you're home all the time, it's a real fight to fight that."
This is all the more acute for customers struggling with reduced income or job loss during the recent economic changes caused by COVID-19, he added. Feeling financially trapped can lead to an increased sense of isolation, especially if you add to the social isolation and self-doubt that came with the pandemic.
"Customers may just need to hear," This is not a normal situation and you take care of it, "says Holliman." Based on compassionate therapy, I ask [clients]'How do you talk to yourself? What is the tone you use? Do you give yourself the credit of dealing with your mental health during all of this? "We all have to do ourselves credit"
Normalization is an important therapeutic tool right now, says Nellie Scanlon, ACA member and LPC at the Slippery Rock University (SRU) Counseling Center in Pennsylvania. Scanlon, a temporary faculty member at SRU, founded a support group in the fall to ask students to talk about the loss, isolation, and other feelings they experienced during the pandemic. The group meets weekly through Zoom.
Like bamboo, Scanlon sees an increase in symptoms of depression and anxiety in the college student population it sees. “A lot of clients use the phrase“ it's okay ”when they really mean they are not okay, and I've encouraged clients to allow themselves to feel what they are feeling and work through those feelings in the session. We are often expected to be okay and move on without acknowledging that our feelings of loss and loneliness are normal responses in times of crisis like the current pandemic, ”says Scanlon, who successfully defended her dissertation and did her PhD in consultancy training at Duquesne University in early fall.
"I also remind customers that they are more resilient than they think," she says. “I ask customers to remember a time in the past when they managed to relax and talk about it. It seems to be important to them personally to remember when they have been resilient in the past, and this increases their confidence to adjust to the current circumstances. "
Of course, there are also some tried and tested measures to combat isolation and loneliness that counselors no longer find helpful or appropriate during the pandemic. The professionals surveyed for this article agree that counselors should bring exposure therapy and similar techniques to market first. They say it is just not appropriate to encourage clients struggling with depression, social anxiety, obsessive-compulsive disorder, or other diagnoses to interact personally with others at this point to prevent isolation.
Bambacus notes that many of the suggestions she normally makes college students to improve their mental well-being, such as: For example, calling a friend to meet up, go to an event or party on campus, or simply get out of the house. Sitting in a coffee shop for an hour is currently not advisable. She was forced to consider other ways to help students make connections and avoid isolation. "This definitely brings out the creativity in all of us – along with the frustration," says Bambacus with a chuckle.
"I think this is a real struggle given the current social constraints from the COVID-19 pandemic," agrees Scanlon, the North Atlantic Region Chair-elect of ACA and immediate past president of the Pennsylvania Counseling Association. “I have encouraged clients to interact with others in ways that are meaningful and effective for them. … Needless to say, there still seems to be an overwhelming loss of personal connection with others as we are limited in how, what, when and where to connect with others due to the pandemic. "
Creative connections
Psychoeducation can be a helpful tool in situations where clients assume that they will not be able to be social during the pandemic or even defend themselves against this way of thinking, says Holliman. Consultants can be ready to make suggestions by drawing attention to out-of-the-box options. For example, Holliman notes that his local library has book clubs that meet through Zoom.
"There are many unique ways we can connect with each other," says Holliman. "Restricted options don't mean that options aren't available, and customers really need to hear that. There are ways [to find connection] but you have to be creative. The consultant has to be a creative co-creator of options."
For many clients, especially those in recovery, the pandemic actually offers more opportunities to attend 12-step meetings and support groups since so many of them are now meeting online, he says.
Holliman recently found psychoeducation a powerful tool while working with a woman with bipolar disorder who was estranged from her family and struggled with isolation. She ended up in the hospital due to dosage problems that resulted in the toxicity of one of her drugs. In a post-hospital session, the client confided to Holliman: "Besides you, these hospital doctors were the first people I spoke to in a long time."
Holliman said he knew prior to this session that relationships were challenging for the client, but her hospital stay served as a turning point and indicator of how acute her isolation had become during the pandemic. During the session, Holliman spent a lot of time normalizing the client's experience with bipolar disorder, emphasizing that support was available, and connecting them to resources including online support groups for those with bipolar disorder. Holliman told the client, "You may feel alone, but you don't have to be alone."
"She had no idea that there were others like her," says Holliman. "She made the comment:" I thought we all just ended up in asylum. "She didn't know [there were supports]. She had just assumed:" That's how life goes. "
Clients with bipolar disorder are at greater risk of isolation because of the rapid mood swings of their disorder and the effects that can affect their close relationships, often leading to these clients becoming estranged from friends and family members, notes Holliman.
According to Holliman, this client has brought about a significant turning point since her hospital stay, including the revival of her relationship with her parents. "Things are not perfect [in this client’s life] but they are better," he says.
Bambacus also emphasizes the need for creativity to help customers find ways to avoid isolation during the pandemic. That fall, she began offering online consultation hours and helped organize a series of faculty talks (including online) for her first generation students on non-academic topics such as cheating syndrome.
At the same time, she encourages her upper-class mentors to organize events for students in the mentoring program, with an emphasis on keeping in touch. If the event is in person, students must hold it outside and limit it to a small number of participants. Other students plan virtual events like game nights and a live cooking show where students demonstrate how to make their favorite recipes on video chat. Still others do low-risk volunteer work, e.g. For example, they write letters to older adults or do an outdoor garbage collection.
Bambacus also checked in with students more often. For those showing withdrawal or avoidance behaviors, she sometimes adds a gentle reminder that she needs to hear from them.
"I'm watching everyone a little more closely," she says. “Especially students who show brave faces often appreciate checking in. … I observe students who are more prone to slowing down and having problems during the semester and those who have previously taken breaks because of their mental health [withdrawn from enrollment]. Often times, the first sign they struggle with is insensitivity. I get creative with my email and give them a deadline like "I need to know by Friday". As soon as they answer, I say, "Hey, you're there. Let's talk!"
This fall, she made her students' focus on self-care and well-being, including the importance of physical activity, good food and sleep, going outside and turning off the news. She also expresses the message that it is okay to ask for help if you have any problems. Even something as simple as encouraging students to call their friends and family instead of texting them so they can actually hear each other's voices can foster a stronger connection, she says.
"It is so healing to know that you are not alone with your feelings of isolation. So give customers the opportunity to see that other people are in the same boat," says Bambacus. “Maybe that means leading more groups and offering these types of services. It can be kept outside or virtually. [It’s] To only have this space in which customers can see that this is not only happening to them and that other people survive “despite” and offer them hope and options. Isolation is such a sneaky thing because you think that you are the only one – you are not just alone; you're the only one alone – and that's just not true. "
Families and isolation: a group work
For families struggling with isolation, Nixon focuses on ways in which they can intentionally prioritize connections within and outside the family unit. With all of the stressors families are facing during the pandemic, it is easy to get into bad habits, he notes. "If you choose to 'this is life,' 'go through the moves," said Nixon, a board member of the Association for Child and Youth Counseling, a division of ACA.
Step one, to be deliberate, often involves creating and maintaining a household daily schedule, advises Nixon. He suggests setting times when family members should focus on work or school and times to focus on connecting as a family, including set times to put away all electronic devices.
Family time should include activities that encourage family members to interact and engage with one another to minimize isolation and promote mental health, says Nixon. This can include anything from going outside and playing in the yard to painting or drawing together, playing board games, having an indoor dance party, or going on a scavenger hunt. (For more ideas, see the article "Supporting Families with Engagement Strategies During COVID-19".)
The lack of personal celebrations during the pandemic, especially those related to birthdays, was difficult for young customers and families. Nixon has helped clients find new ways to connect with family and friends to celebrate special occasions, including blowing out their festive candles during video chats and organizing walk-in or passing "parades" of well-wishers.
Similarly, many teenage customers of Nixon miss the personal interactions they would typically have with friends and peers through school and extracurricular activities. Here, intentionality also helps to fill the gap. Nixon is asking teenage customers to find out what they liked best before the pandemic. The answers usually include hanging out with friends, watching movies, or playing video games together. One way his customers have adapted is to set a specific time to watch a movie with friends (each in their own home) at the same time, and then text or video chat with each other while watching.
Nixon also encourages family customers to find replacements for things they loved to do together before the pandemic. In meetings, he uses a whiteboard to visualize customer ideas and encourage dialogue.
“I get their perspective and talk about what their preference and focus were before the pandemic. Was it at meals together? Then be there now on purpose. Or if exercise was really important, organized sports might not be an option, but they can play as a family or take time to sit down and review and analyze tapes from previous games, ”said Nixon, a past president of the Idaho Counseling Association . "Identify what was important for [clients] before and help them realize that it is still important and how to find a new context for it."
Counselors can help clients find new rituals by identifying the main reason they enjoyed certain activities prior to the pandemic. Ask: “Why do families do what they do and how do they mean it? Then try to find something else that gives them the same meaning in a different context, ”advises Nixon.
For a family in Nixon's case, family meals were very important and they made a connection by eating out together. This became more difficult when many restaurants closed their dining rooms in the spring and summer.
Nixon helped the family redesign this ritual and brainstorm methods that would allow them to recreate the aspects of eating that they liked best. After the breakdown, the family identified the main features they enjoyed as trying new restaurants and experiencing new cuisines together. The family had a self-imposed rule never to eat in the same restaurant twice in a month or to have the same type of cuisine twice in a week. That's why they were always looking for new places to try, says Nixon.
“For them, the adventure of trying something new and ordering something to share with someone at the table was important,” he says. "The intention was to be adventurous, to try something new and to share it together."
When they came to this realization, Nixon suggested that the family experience new foods together by learning to cook them at home. Your first answer? "We don't cook," recalls Nixon.
Unimpressed, Nixon suggested that the family search the Internet for ideas and videos with instructions. The family started off small, made an appetizer, and found it easier than they thought. From then on, the activity blossomed of setting aside one night a week to repeat dishes they had previously enjoyed in restaurants.
"They didn't want to screw up and fail, and they didn't want to waste time and money [on specialty ingredients]. But they found that nothing was ever a failure, like when they went to a restaurant they didn't It was the attempt they enjoyed, "says Nixon.
Now that restaurants have reopened, this family continues their home cooking adventures. They put aside the money they save by eating at home for the occasional restaurant meal that they would have previously considered a treat.
"The opportunity this family took to take a step outside of their comfort zone brought them closer together," says Nixon. “They found that family members have skills that they hadn't fully seen before, and they found that small changes always had an impact on the family. In the past the small changes were seen negatively, [but] now they see the opportunity and positivity that can come within the family. "
Looking ahead
Nixon says he has pondered the long-term mental health implications of the COVID-19 pandemic, particularly the increased physical and social isolation that will return for many people over the winter months. As cases of COVID-19 in the US continue to rise in connection with the introduction of the traditional flu season, it is possible that states or localities could reintroduce some of the strict lockdown measures such as school and business closings that have already taken place in the US Spring.
It is possible that counselors see an increase in clients not only in isolation from behaviors, but also in feelings of hopelessness and thoughts of suicide, says Nixon. With that in mind, he increases his screening of customers for security, harm, and abuse, and ensures that he shares resources like crisis hotline numbers.
"I've been thinking a lot lately: how to help families and customers with the potential for longer home stays and the long-term aspect of the coming winter," says Nixon. “How can families be deliberate [to avoid isolation]? What is important for the family [a client’s] and how do you keep this embers burning? "
****
Contact the consultants interviewed for this article:
****
Bethany Bray ist eine leitende Autorin und Koordinatorin für soziale Medien bei Counseling Today. Kontaktieren Sie sie unter [email protected].
****
Es sollte nicht davon ausgegangen werden, dass Meinungen und Aussagen in Artikeln, die auf CT Online erscheinen, die Meinungen der Herausgeber oder Richtlinien der American Counseling Association widerspiegeln.
