2020: The year that surprised us again and again – and often shocked us. Rampant forest fires on the west coast. A record-breaking hurricane season. The violent police confrontation and subsequent death of George Floyd, which sparked widespread protests, re-proclaimed Black Lives Matter and called for an end to racial injustice and police brutality targeting black communities. A marked increase in terrorism by white supremacists. A sharp and bitterly divisive presidential election.
And everything about that? The destruction of the novel coronavirus COVID-19, which is responsible for the deaths of more than 300,000 Americans.
Throughout all of this, consultant practitioners have navigated an ever-changing landscape. Pandemic safety protocols required a swift move to telehealth sessions to test the consultants' flexibility and technological know-how. The number of cases rose sharply during the year. Counselors adapted and helped clients process anxiety, stress, grief, and trauma while dealing with many of the same problems on their own.
CT Online asked advisors to reflect on this extraordinary year. We wanted to learn about their challenges and successes, their losses and unexpected gifts. How did they adapt? What did you learn? And what advice could you give your colleagues?
Here are some of their stories:
Kimberly Johnson is a licensed mental health counselor specializing in Compassion Fatigue in Long Beach, New York. She is also an Assistant Professor in the Clinical Mental Health Advisory Program at Touro College in Brooklyn, New York.
The effects of working alone were unexpected. I'm used to interacting with clients and advising students on a regular basis. Suddenly my dogs and my husband were my constant companions. The ones I've worked with – be they clients, students, or colleagues – have been two-dimensional and on zoom. I felt my world was being lived from the waist up. I learned to read people differently and to connect in such a way that actual eye contact (one of my mainstays) was not guaranteed due to technology. I learned to find new ways to connect with my consulting world. Workouts, podcasts, and chat groups – never really my stuff [previously] – became invaluable.
I've learned that I have to draw a more definite line between my work and my private life. Work stayed in my home office and when I left no work went into my personal life (unless I made a deliberate decision to cross the line). "Downtime" took on a whole new meaning – I had to make a more conscious choice to be absent.
Therapy by telephone and video can be powerful and useful. I'm old-fashioned – pre-internet practice was an important part of our counseling discussion – before cell phones, zoom, or texting. I believed that the best therapy is personal. I learned that I can practice good therapy from a distance. I've learned to change my approach, look at customers differently, and use new tools and senses to connect with customers and advise students. I won't be unhappy if I return to a more traditional counseling and teaching approach – but I know that because of this experience, I will be better in both therapy and teaching.
Be open to the idea that what you thought was best clinical practice can be reinterpreted. Be flexible – life throws the unknown at us and we can adapt. Being able to say no – self-care was the most important part of 2020 (sometimes I can come first). Let yourself be grieved – it's okay to acknowledge that sometimes this can really "suck" for us too.
David Lawson is a Counseling Psychologist, Licensed Professional Counselor (LPC), and Clinical Supervisor with Change Incorporated consulting firm of St. Louis. He is also a professor of counseling at Palm Beach Atlantic University.
In the past 25 years I have had the privilege of going through many crises with people. While personal crises are generally the most painful, there have been two other times during my practice that I remember having to support clients and therapists alike who were overwhelmed by the consequences of a national crisis.
In 2001 I sat with many who were absolutely devastated and mourned the innocence that was lost when we wrestled with one of the most significant attacks on American soil. And in 2008 I spent a lot of time helping people cope with the losses of their homes and businesses as the economy broke up and almost collapsed around us. Both crises were overwhelming and absolutely life changing, but in either case we could come together to share with others in helping the pain and loss, and that made all the difference.
But nothing could have prepared us for what happened in 2020. And the only reason we survived this crisis for so long is because people are very adaptable. For a short time, we can endure tremendous stress and pain and withstand prolonged physical challenges. But the 2020 pandemic – and especially the stress counselors have been under from the start – has challenged even the most capable, and is radically different in almost every way from 2001 to 2008.
Counselors had to accommodate all of the challenges they faced, including dealing with physical and emotional stress, the stress of family and friends in their support system, the general loss of support systems they could rely on, and confusing Educational needs for children while keeping the stress of their clients.
We had to relearn how to deal with and deal with mutual layers of stress that occur in waves, as the constantly changing environment affects each of us in different ways and at different times. For many, COVID-19 felt far away at first, a distant slip on life's radar. Over time, those who weren't directly affected watched circles of family members and friends who had remained disease-free shrink until the pandemic hit them. Many counselors have observed how other therapists and friends slowly succumbed to the desire to escape their isolation and loneliness, became infected, or quarantined because they were around other infected people, thereby increasing the loneliness in their own lives.
It is this part of the pandemic that has been the most painful and egregious for consultants – and that is the most different from previous crises. The lack of clarity and confusing messages from medical leadership about effective safeguards as well as the general vacuum of leadership at the national level have confused many counselors as to what is appropriate and what is risky, and this has only added to the general level of confusion and stress. Constant isolation and loneliness, whether due to a lack of interpersonal connection or an inability to touch others, has compounded any feeling – especially negative feelings – resulting in therapists and clients alike experiencing almost delusional or hallucinogenic states.
Even those who have been effective at dissociation have not escaped the grip of isolation and loneliness because no one can dissociate long enough to completely avoid what happens without completely breaking down. Ultimately, our adaptability saved us again, and we survive, and some thrive in the middle of the pandemic.
Consultants have started to discover new ways to connect and interact with one another. A year ago no one had heard of Zoom, and now it's a lifeline between therapist and client and a great meeting place. We learned how to meet outside while it is still warm and sharing space at a safe distance. We have learned to read people's eyes more clearly, because for many, that's all we can see with masks on. We also learned how much time we spent mindlessly shopping and wandering around. I think this is one of the greatest lessons I have discovered for myself and found in working with other consultants.
And above all, I think a lot of people have taken the time to be quiet, to be calm, to enjoy simple things. Being present is such a lost art even among advisors, and I think the pandemic has given us the opportunity to be present again.
Marina Brink is an LPC with a private practice in Pittman, New Jersey. Her areas of expertise include counseling on anxiety, depression, highly sensitive people, maternal mental health, and intuitive eating.
This was a challenging, transformative and special year. When the quarantine began in March, I was gripped by fear. I was worried about my family's health and how I would continue to work. Some colleagues were not concerned and said it was all business as usual. However, it soon became clear that our world was about to be shaken. If I wanted to continue working, I had to get involved in telemedicine. Honestly, it was annoying at first. I've always been confident in front of a camera. I was basically forced to undergo "exposure therapy" because of my video fear! Now I'm used to seeing my face on video every day.
Some customers did not want to conduct telemedicine sessions. However, in May, I suddenly got more referrals than ever before. The uncertainty of time also affects us consultants. I had to "put my money where my mouth is" by taking care of myself. I started doing guided meditations daily. I've read more books this year than ever before. When I went outside, I erased the cobwebs.
Nevertheless there are still many difficult moments and days. Not knowing when the pandemic will end is nerve wracking. The racism and political tension in our country are similar to cancer cells. We all need to heal from multiple trauma. As a white cis woman, I have to find out more about systemic inequalities and actively work towards change.
As a mother and therapist, I am constantly learning to juggle my roles. My children study remotely, while my husband and I work remotely. I miss my commute to work where I enjoyed the time and space to decompress before and after clients visit. Still, I love to wear my comfortable yoga pants while working. Since I have younger children, I have to oversee their distance learning which has made me appreciate their teachers more than ever. I had to juggle my schedule with clients. When I do everything from home, I sometimes feel guilty about not being able to work with more clients because I currently have to prioritize my children's learning needs.
This special year taught me to appreciate everything I have. It's a cliché, but health is so important. I am very grateful that my family and I were healthy. I was deeply saddened when a friend's parents died of COVID-19. My heart broke for another friend whose sibling had committed suicide. Our common humanity is so fragile and beautiful. I am really grateful that I made the decision to become a consultant. It is an honor for me to do what I can in my little corner of the world to try to make a difference.
Cheryl Fisher is a licensed private practice clinical professional counselor in Annapolis, Md. She is the director and assistant professor for the online MA in clinical counseling for the Alliant International University California School of Professional Psychology. Her research interests include the study of sexuality and spirituality in young women with advanced breast cancer; nature-informed therapy; and geek therapy.
2020 has been a challenging year and no one knows better than mental health providers. In March, I switched from face-to-face sessions to telehealth. As the uncertainty about the pandemic increased, my clients' fear increased. My practice grew rapidly. My emergency slots were filled every week and the breaks between meetings quickly became obsolete. Day after day, I sat in my home office listening to the fears of my customers, some of whom are medical assistants describing the worst of the worst cases of COVID-19. I would help each client identify and use self-care tools, take a deep breath, and click "Start Meeting" to begin my next Zoom session. I experienced hours of telehealth sessions filled with customer fears that merged with my own.
One evening my husband and I were driving around our small town of Annapolis after the Phase 1 COVID restrictions were lifted. It looked like carnival – minus masks of any kind or social distancing. My husband commented on how nice it was to see everyone. However, I got into a tirade about how irresponsible these people were. Didn't they know how hard the medical service providers were working to save the lives of the people in the COVID-19 units? Didn't you know that people die ?! I was so angry. After more than 20 years of clinical practice, I was surprised to find that I had secondary trauma. My self-care already includes daily workouts and meditations, but these were not enough to endure the stress I had in my own life and in my practice. I regrouped, immediately stopped taking in new customers, and took breaks all day to walk, eat, and play with my dog Elsa.
The blurring of the boundaries with telehealth became evident early on with the invasion of customer homes and the use of virtual backgrounds to hide my makeshift home office in the guest room. Max, my beloved 12 year old golden doodle co-therapist, died suddenly that summer leaving me and my 2 year old poodle therapist in apprenticeship mourning. In her grief, Elsa insisted on being around all day, and when she got bored of screen time, she would crash telemedicine sessions to get my attention or bark at passing neighbors. It was both frustrating and weird, but I've learned to embrace the unpredictability that comes with working from home. Customers are now asking for Elsa and we are sharing screen time.
Zoom fatigue was another surprise! At first it was so wonderful to see friends and family in virtual gatherings. However, after weeks and weeks of Telehealth, I started pulling the power plug whenever I could. Being outdoors has always been a priority for me, but now it has become a necessity. I even started doing telemedicine in the privacy of my backyard. With earphones in and privacy screen up, I sat between my potted herbs and bird feeders and conducted virtual ecotherapy sessions that benefited both me and the customers.
With all the challenges, however, what strikes me most is how resilient we are as advisors (and people). The pandemic allowed me to review my priorities, improve my self-sufficiency, embrace the unpredictable, and spend my time with nature and its creatures. We continue to face everyday obstacles with compassion, innovation and imagination, becoming better therapists and people in the process.
Lauren Thayer is a provisionally licensed professional advisor practicing with the St. Louis consulting firm Change Incorporated.
The past year was certainly the year of challenges. Each facet of 2020 highlighted the many ways our society is still unfair – and the uncertain and difficult way forward. The year also showed how divided we are as a population. These challenges in themselves are not new to society or this particular point in time – they have existed since the beginning of civilization. The challenge today, however, is for the two to coexist at the same time, creating a force that keeps us further apart, both physically and for moral reasons. With every round, whether it's media or scraps of conversation, we may become aware of one of these challenges. This awareness pulls our sense of morality and justice, but it can also jeopardize our sense of self-preservation. This conflict can shake us at the core of our identity and sometimes provoke defensive reactions to a perceived threat, not just to ourselves but to society as a whole.
With this realization I had to learn as a therapist to challenge and question myself and my awareness of my own truths and at the same time deal with my fears and unspoken fears with regard to the current state of the world. I believe that awareness is necessary in order to create empathy and understanding in situations that are very different from our own values. This in itself, of course, is an ever changing and difficult process in which I try to allow myself as much grace as I would give to another clinician or client.
This split was an unexpected opportunity for me to challenge myself to sit uncomfortably on the other side of the fence in order to turn my own confidence into a professional dynamic. As a clinician, I have often found it easier to sit with the discomfort and challenging emotions of clients and still distance myself. That way I could avoid my own discomfort and only confront it in the safety of my own space. In the past year, however, the inevitable awareness of white privilege; severe brutality against people of color; an impending threat to our physical wellbeing; and a government that prioritized money over people has made that discomfort inevitable in every facet of life. So I started to bring my own reactions into the work and found that so many of my clients experienced similar feelings of insecurity as they were forced to control the awareness and emotions they had previously avoided. This has created a sense of compassion and understanding that previously felt hopelessly aloof.
Derrick Paladino is a licensed clinical mental health advisor based in Winter Park, Florida. He is also Professor of Clinical Psychological Counseling at Rollins College.
"I'm tired of white people." "I'm tired of my white friends." "I'm tired of my white customers." Hearing any of these statements as a consultant or supervisor is an absolute privilege and an absolute honor. This means that you have created an environment that opens the door to valor. As I think about the past few years and current events, I am continually concerned about the increasing explicit nature of racial injustice. This is not new to anyone. As a minority, I have been dealing with racism, discrimination and hatred since my youth. What we are experiencing today, in my humble opinion, is a lightning rod that has created a safe place where more and more people can openly convey hatred without consequences – and make those without power even more powerless. We have also seen demonstrations for racist and underrepresented justice that show the pain, pain and anger of those who live without privilege.
These demonstrations draw attention to the covert and overt nature of systemic “isms” that have been hit hard. When you hear the phases “I'm fed up with white people”, “I'm fed up with white friends” and “I'm fed up with white clients”, you experience a client or supervisee who is struggling with an indifferent system. Your job is to listen and your job is to believe your client or boss.
Besides, your job is not to wait for it. If you're waiting for clients and supervisors to say certain things, chances are you'll never hear that important part of them. It is normal to use advanced cultural empathy to ask your underrepresented client or manager how they are doing on current events. This creates compassion, gives strength and invites safety. Since we are all in an area that requires constant reflection and education, one should look at their clinical style and past sessions to see if they consistently create environments in which these experiences can be freely spoken. If not, it's not too late and we still need you. Consultants and supervisors should be vigilant with this personal assessment as the world moves as a cultural being through the presentation of your client's topics and experiences. Customers and supervisors live in ecological systems that we should understand.
Whether you are a professional with privileged or underprivileged identities, please know that this work is so important. As an under-represented consultant and supervisor, it is not unusual for me to feel the same way about our privileged society and to experience stress. I also need to do my own work and seek advice to reflect on how this can affect the environments I create in the session.
My final message goes to all under-represented counseling students and supervisors who are reading this. It is normal to have problems with the way the world and the system affect your clinical responsibilities. Know that you will not find a safe place with every professor, supervisor and advisor – and that is a fact. Discover those inside and outside of your program and peer groups who are actively open to your experiences. Share with those who know how to keep the space for these thoughts and feelings. Remember, it is the responsibility of the advisor and supervisor to create this space, not yours.
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Ulash Thakore-Dunlap is a licensed marriage and family therapist with a private practice in San Francisco. She specializes in managing anxiety, the needs of school, work, and wellbeing, and supporting color communities.
My biggest challenge as a practitioner during the pandemic was working from home. Before the pandemic, I loved to physically go to my work place to see clients and teach. This really helped me separate work and family. When I got home, I was able to focus on hanging out with my family. The pandemic challenged me to set limits at home because I can easily continue working late into the week and on weekends.
In order to separate my work from my private life, I had to learn to set strict boundaries: schedule a certain time to stop work, schedule customers in blocks and include more breaks in my working day. These strategies have really helped me better manage my work schedule and sustain myself, and have helped me feel less tired and overwhelmed. What has helped me the most in supporting my wellbeing is forcing myself to schedule a day off every four weeks. I have noticed that this has been an immense help in taking care of myself and reconnecting with my family during my day off.
Another challenge is to feel guilty about not being able to accept more customers. I have a very small practice because I teach full-time in a master's level counseling program. The pandemic and ongoing racial injustice have increased stress for everyone, but especially the color communities. Since the beginning of the pandemic, I have received an increased number of calls and emails from BIPOC people asking for advice. I feel guilty for not being able to serve all of my parishioners, especially because many people of color have never asked for advice or have had no positive counseling experience in the past. I've learned to deal with this by working through my guilt for not being able to see more clients and referring people to other trusted color clinics.
The pandemic has had a positive effect on the way I work in my practice and the support I receive from my customers. When I work from home, I have learned to be more authentic to my clients when I share the realities of working from home. In addition, like my clients, I too have problems reconciling work, family and life and dealing with racist injustices. Where appropriate, and when this is part of my client's treatment goals and plan, I have shared my struggles without giving specific details. Just mentioning the pandemic struggles such as “I also have problems reconciling work and family” or “I have also experienced racist injustices” gave my clients the feeling of being an authentic therapist. I also believe that providing telemedicine and online counseling requires great skills. Due to COVID-19, all of my consultations are now via telemedicine. I had to adapt and learn new online strategies to support my clients. I feel like I have learned so much how to effectively support clients through teletherapy.
Finally, I would like to share this time with my fellow consultants. Please watch out for burnout and fatigue. Like our customers, we can experience stress factors in our lives. I encourage my fellow counselors to take care of themselves and use their support networks.
Ron Laney is a licensed professional advisor practicing with Change Incorporated consulting firm in St. Louis.
Without a doubt, my greatest insight from the past year was the confirmation of how important self-care is for my general well-being. When the COVID-19 pandemic first set in here in mid-March, I expected it would only be about a month before we would get back to life as usual, and here we are now, more than ten months, with one further increase in infections nationwide. Obwohl ich mir des enormen Leidens, das Menschen weltweit durch dieses Virus erleiden, sehr bewusst und sympathisch bin, findet ein Teil von mir das Mandat, die Befreiung zu verlangsamen. Es ist, als hätte ich die Erlaubnis erhalten, in meinem eigenen Tempo zu leben und nicht das Gefühl zu haben, dies oder das zu tun, nur weil es in der Kultur verwurzelt ist, dass ich irgendwie glücklicher oder erfolgreicher wäre, wenn ich es tun würde.
Trotzdem gibt es sicherlich Zeiten, in denen ich gerne mit Freunden ausgehen oder mehr Zeit mit meinen beiden erwachsenen Kindern verbringen würde. Es ist nur so, dass ich zumindest vorerst das Glück habe, nicht den Grad an Enttäuschung oder Müdigkeit zu erleben, dem andere begegnen könnten, während ich nicht in der Lage bin, zu einer vorpandemischen Lebensweise zurückzukehren. In diesen Zeiten, in denen ich Probleme habe, biete ich mir jedoch sanft die gleiche Ermutigung an, die ich Kunden gebe, die Schwierigkeiten haben, sich in dieser schwierigen Zeit zurechtzufinden: Sei freundlich zu dir selbst – in diesen Tagen ist viel los: die Pandemie, a giftiges politisches Klima, soziale Unruhen, Isolation usw. Und wenn unvermeidlich Gefühle der Einsamkeit auftauchen, erinnere ich mich an diejenigen in meinem Leben, die ich liebe, und erinnere mich daran, dass ich im Gegenzug geliebt werde.
In Bezug auf meine Arbeit als Therapeut muss ich sagen, dass sich die Aufsicht, Unterstützung und Ermutigung, die ich von meinen Unternehmenskollegen erhalten habe, als äußerst hilfreich erwiesen hat. Während wir derzeit möglicherweise nicht in der Lage sind, Hallo zu sagen, wenn wir zwischen den Sitzungen auf dem Flur vorbeikommen, treffen wir uns mindestens einmal im Monat praktisch eine Stunde lang, um einzuchecken und zu sehen, wie es uns geht. Wir treffen uns auch vierteljährlich online für ganztägige, erleichterte Gruppenerlebnisse, von denen ich immer energiegeladen und emotional leichter weggehe, weil ich die Gelegenheit hatte, sowohl als Fachleute als auch, was vielleicht noch wichtiger ist, sowohl einzeln als auch gemeinsam zu teilen, was wir durchmachen , Menschen.
Tammi Lewis ist LPC bei Valley Health Systems, wo sie medikamentöse Behandlungen und verhaltensbezogene Gesundheitsdienste anbietet.
Zu sagen, dass 2020 ein interessantes Jahr war, wäre eine Untertreibung. Mein Bundesstaat West Virginia war der letzte Bundesstaat, in dem positive Fälle von COVID-19 aufgetreten sind. Unser Gouverneur tat jedoch sein Bestes, um dem voraus zu sein, indem er Schulen schloss und einen Aufenthalt als Hausordnung festlegte. Das bedeutete, dass unsere Praxis auf Telemedizin umgestellt werden musste.
Ich biete medikamentenunterstützte Behandlung (MAT) und Verhaltensmedizin bei Valley Health Systems, einer integrierten Pflegeeinrichtung.
Im März wurde alles geschlossen, daher mussten wir herausfinden, wie wir Dienste so schnell wie möglich und schnell unterbrechen können. An unserem Standort bieten wir sowohl Einzel- als auch Gruppentherapie an und wollten so wenig Störungen wie möglich. Unsere Abteilung für Verhaltensgesundheit hat sich schnell auf Telemedizin umgestellt, insbesondere bei unseren einzelnen Kunden. An dem Ort, an dem ich arbeite, haben wir nur eine Woche Gruppentherapie mit unseren MAT-Kunden verpasst, bevor wir zu Zoom gewechselt sind. Unser Programm funktionierte wie gewohnt für die Kunden – das Format der Leistungserbringung war für sie die einzige wirkliche Änderung.
Wir als Kliniker wussten nicht, wie ermüdend es für uns sein würde, Telemedizin zu betreiben. Das war die erste Herausforderung – Müdigkeit. Wir bewegten uns weniger im Bereich Telemedizin und standen nicht auf, um Kunden dazu zu bringen, sie in unsere Büros zu bringen. Wir saßen also mehr als sonst tagsüber. Ich habe einen Tischkonverter auf meinem Schreibtisch, der hilfreich war (und ich würde es sehr empfehlen), um den Druck vom Rücken zu nehmen. Ich bin auch ein persönlicher Trainer, und Sitzen ist das Schlimmste, was wir für unseren Körper tun können.
Eine weitere Herausforderung bestand darin, dass sich unsere Zeitpläne nicht geändert hatten. They remained full, with back-to-back [clients] and then we had an increase in the number of clients we were seeing due to increased anxiety, depression, and stress secondary to COVID-19. However, we didn’t realize how these stressors were adding up until we were many months in and we were feeling burned out, tired and exhausted. This was not good for us or the clients. Because we work with the substance use disorder population, we had the additional stress of making sure they had the tools they needed to remain sober.
I had also not taken any time off since all of this started and it was starting to wear on me. In addition, as the primary caretaker of my 96-year-old grandmother there was the stress of making sure she was safe and healthy. In addition to the issues surrounding COVID-19, as the killing of George Floyd inspired widespread protests calling for social justice, I faced the stress of being a Black clinician working with primarily white clients and my status as the only Black staff person in my building.
At one point of exhaustion and frustration, I sought out supervision from a friend and mentor for guidance and direction. We talked for about two hours (socially distanced) which was helpful. As a result, two counselor colleagues and I formed a peer support group to discuss the challenges that we had and provide support to one another. This has been very helpful, and I highly recommend such groups to other clinicians. I also started putting two 30-minute breaks in my schedule, at the suggestion of our administrative team, which gives us a chance to document, get up and move, or just be away from the computer screen.
I think one of the things that has bothered me throughout this is the discussion regarding the frontline workers and all the work they have done, which is true. However, they have been told to make sure they keep up their mental health and seek out counseling if they need it. But no one ever thinks about the people they are getting the counseling/therapy from. We don’t wear capes and it has been a difficult eight/nine months for us as well. But we must put our own anxieties aside and do what we need to do, just as those other frontline workers. And we are happy to do so because it is the job we chose to do.
Lastly, one of the of things I learned and have tried to get my clients to understand is gratitude. If a pandemic had to happen, this was the best time for [it] to happen. I know there has been a lot of talk about isolation, however, it could have been much worse. If this was 1986 or 1990 we would not have had the technology we have now to keep us connected in the way that we have been able to that allowed us to maintain contact with our clients (or families), providing them the access they needed for treatment. The isolation could have been much worse and I believe that’s an aspect we have taken for granted.
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Add your own reflections on 2020 – the year’s challenges and bright spots – in the comment section, below.
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Laurie Meyers is a senior writer for Counseling Today. Contact her at [email protected].
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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.
