By Lindsey Phillips
The COVID-19 pandemic is affecting everyone differently. Some are coping with the loss of a job. Some are risking their lives caring for those who are sick. And others find themselves deeply contemplating existential questions of mortality and the meaning of life.
The pandemic could also be compounding underlying mental health issues for some clients, notes Robert Haynes, a member of the American Counseling Association. For instance, clients who were already battling depression or obsessive-compulsive disorder may now be dealing with a significant amount of anxiety and stress on top of that related to COVID-19. Those confronted with social injustices because of their race, ethnicity, sexual orientation or disability may also be more affected, he adds.
“People are going to be all over the spectrum as far as how they’re doing, what they’re doing and how it’s affecting them,” Haynes says. “Don’t assume anything, even if you’ve been working with a client for some time. This [pandemic] may be a huge setback for them.”
Many people have not dealt with this level of stress before, and some are having newfound anxieties, which can be jarring, says Shainna Ali, a licensed mental health counselor (LMHC) in Orlando, Florida. The pandemic may also uncover an unaddressed mental health concern that could benefit from counseling, she adds.
People’s ability to cope with stressful events has been and will continue to be tested by the COVID-19 pandemic. During this time when mental health is moving to the forefront of the public’s consciousness, professional clinical counselors are in a prime position to help clients cope with uncertainty and loss, build resilience, adjust their coping strategies and self-care routines, and identify their individual and community strengths. And counselors, of course, can best help their clients by remembering to also take care of themselves during this challenging time.
Coping with uncertainty
Uncertainty surrounds this global crisis. No one is quite sure what to expect or what the next day will hold. The uncertainty, fear, and unknown with COVID-19 create the perfect formula for anxiety, says Haynes, co-author, with Michelle Muratori, of the recently published ACA book Coping Skills for a Stressful World: A Workbook for Counselors and Clients.
A common response to this uncertainty is trying to seek control, Ali says. Throughout this pandemic, Ali, owner of Integrated Counseling Solutions, has constantly been reminding clients, “Manage what you can. Release what you can’t.” Fixating on what you can’t control leads only to rumination, but focusing on what you can manage is one way of coping with a stressful situation, she says.
For example, an adult client might worry about their parents and how well they are isolating during the pandemic. The client may want to visit their parents but also fear making them sick. Ali would advise this client to find another way to check on them (one that aligns with the Centers for Disease Control and Prevention guidelines) such as calling or doing a video chat.
“Focusing on what we can control might help us to feel more grounded,” says Muratori, a senior counselor at the Center for Talented Youth and a faculty associate in the school of education at Johns Hopkins University in Baltimore. Counselors can help clients set small, achievable goals and take time to reflect on what they have accomplished each day. For example, clients can ask themselves, “What is one thing I can do today to move toward accomplishing my goals?”
People can also control the type and amount of information they consume. As Stephanie Dailey, an assistant professor of counseling at George Mason University, points out, overexposure to media tends to increase people’s levels of distress, fear and anxiety during disaster situations, regardless of whether they were involved in the crisis.
“Accurate and timely information is important,” says Dailey, a licensed professional counselor in Virginia. “But if a client is constantly on social media and is accessing sensationalized or erroneous information, it’s going to undermine their mental health.” She advises counselors to inquire about how much access (or over access) to information clients might have.
Coping with loss
Not all loss is obvious. A couple mourn the cancellation of their vacation plans. A high school senior is upset because he won’t be able to experience graduation with his friends. A young child misses her first Broadway show. Neighbors are no longer able to relax and celebrate the end of a workweek by having dinner with one another in their homes on Friday night. Baseball fans lament the start of the season being postponed.
Loss is upsetting because it highlights what we no longer have or what we could have had, explains Ali, a member of ACA. She helps clients more fully understand what they are truly mourning and validates their appropriate emotional responses to the loss, such as sadness, anger and frustration. But she also helps clients see possibilities for experiencing gratitude even in the midst of loss.
For example, if a client is upset about not being able to get married when originally planned, Ali first reassures the client that feeling that way is OK. She may then ask the client to think about something for which they are grateful. The client may respond, “I still have my partner.”
Ali, author of The Self-Love Workbook and the blog A Modern Mentality (hosted by Psychology Today), finds gratitude a particularly valuable coping skill currently because “right now, it’s really easy to get distracted by the negative.” Encouraging clients to be grateful and to look for the positive isn’t meant to undermine or minimize negative emotions, she asserts. Rather, it deters clients from ruminating on the negative.
Ali might also ask the client upset about their postponed wedding, “How can you still honor what you have?” This question would help the client refocus their energy on what can be managed (such as revising their wedding plans or planning an at-home date night) rather than wrestling with what is beyond their control, she explains.
Haynes and Muratori say that resilience is one of the key components of being able to cope with stressful events. Some people incorrectly assume that resilience is innate, but it can be learned, asserts Haynes, a clinical psychologist and producer of psychology video programs for Borderline Productions. “Resilience is more what you do than it is who you are,” he explains. And like any other skill, it grows stronger with practice.
Counseling techniques that help clients connect with others, adjust their thinking and beliefs, become more optimistic and flexible, practice self-care, attend to the spiritual dimension of life or promote self-compassion can bolster resilience, Haynes says.
In Coping Skills for a Stressful World, Haynes and Muratori share an exercise for strengthening client resilience. It involves clients tracking their reactions to stressful events for a period of two weeks and asking themselves some questions: What did they feel and think about the situation? What actions did they take to resolve the crisis? How effective were those actions? What did they learn? The exercise encourages clients to consider their own strengths and the ways they already cope with stressors. Clients come to the realization that they can use these same tools that they already possess when facing future crises, Haynes and Muratori explain. (The use of out-of-session exercises and activities such as this one is a major focus of their workbook.)
Ali works with clients to create their own toolkits of general self-care and coping skills that may be helpful during difficult times. It is important that people establish a general self-care practice rather than waiting to focus on coping skills during a crisis, Ali notes. She says that everyone’s coping skills during a stressful event will look different, but she advises clients (and counselors) to break into their “emergency coping kit” and find activities that help them manage stress.
Dailey, an ACA member who specializes in disaster mental health, finds ways to tap into her clients’ strengths to promote resilience and coping. If a client enjoys art, for example, Dailey may recommend painting or drawing as a possible coping tool. If a client is a natural helper, Dailey might have them brainstorm ways they could support others during the COVID-19 crisis, such as making masks or volunteering virtually. Spiritual or religious practices also provide an enormous amount of strength for some clients, she adds.
“Communities and individuals are innately resilient,” says Dailey, co-author of the 2014 article “Shelter-in-place and mental health: An analogue study of well-being and distress” for the Journal of Emergency Management. “Everyone has strengths, and this crisis can be an opportunity to find those strengths.”
As Muratori, an ACA member, points out, learning coping skills and resilience is not just something that will help clients get through the current COVID-19 crisis. It will also prepare them for future crises, large or small.
Adjusting coping and self-care strategies
“One of the skills in being resilient is also having some flexibility,” Muratori says. That is particularly relevant now because the COVID-19 pandemic has forced people to constantly shift and reshift their schedules while also creating new routines.
It is natural for people going through challenging times to engage in rigid thinking such as “I can’t stand this,” Muratori says. She advises counselors to remind clients that they are standing this; they are adapting and adjusting.
Many of Ali’s clients thrive with routine, but those routines have repeatedly been disrupted by physical distancing, quarantine and gradual reentry. Some of her clients were used to having a clear distinction between their home lives and work lives, so being forced to work from home has created new challenges for them around establishing and maintaining boundaries.
Ali works with these clients to recognize their personal boundaries and to establish some sort of new routine for themselves. She encourages clients to use a semistructured routine, in which they set their intentions for the day but also remain flexible to accommodate new circumstances as they arise.
Dailey also advises clients to maintain a regular routine as much as possible. She encourages them to focus on the basics, such as waking up, showering, eating and going to bed at the usual times.
Ali says that social connectivity remains an important coping strategy during the COVID-19 pandemic. “Social distancing and social isolation are not the same,” she emphasizes. Ali advises clients to think of creative ways to continue meeting their social needs. For example, if clients previously coped with a stressful workweek by going out to dinner with friends, perhaps they could consider hosting a virtual dinner party.
Likewise, clients may need to adjust their self-care regimens right now. After first defining self-care, Ali says, counselors can help clients brainstorm self-care techniques that have worked for them in the past and then look at how they can adapt those strategies (if necessary) to work in an environment of physical distancing or gradual reentry. For example, if a client previously coped with stress by going to the gym, how could they still fulfill that need while gyms are closed? Could they take a remote fitness class or go for a run instead? (For more on this topic, read Ali’s ACA blog post “Self-care & social distancing: Helping clients adjust during COVID-19” at tinyurl.com/ACAMemberBlogAli.)
“Any tools that will support relaxation are really critical at this time,” Dailey emphasizes. She finds mindfulness an effective technique for helping clients regulate their emotions because it encourages them to pause for a moment and let their bodies catch up with their brains. In turn, emotion regulation helps clients successfully manage their symptoms, maintain focus for day-to-day problem-solving and attend to physical needs such as eating, sleeping and taking the proper medications, Dailey says. Clients can journal, go for walks, spend time outside, exercise, meditate, do breathing exercises or do grounding exercises to manage their anxiety, she adds.
Counselors can also play a role in making self-care fun. To help boost self-care, Ali challenges clients (and herself) to combine various coping strategies. For example, a client could livestream a fitness class with a friend, or a family could do a gratitude reflection together at dinner.
Coping as a community
Muratori says that the COVID-19 pandemic exemplifies communal shared trauma — a traumatic event that affects an entire community directly, indirectly or vicariously. The good news is that community members are finding ways to support one another.
In Dailey’s community, neighbors stood on their porches one night and clapped into empty space to show their support for health care workers. They also placed stuffed bears with hearts on the chests in their windows to show their love for one another. Members of Haynes’ neighborhood also placed stuffed bears in their windows so children could go on a “bear hunt.”
Counselors can encourage clients to look around their communities and notice these resilient acts, Dailey says.
Ali specializes in individual mental health counseling, so her clients typically come to her to work on their own individual concerns. But since the COVID-19 crisis began, Ali has noticed that her clients are also showing more concern for the mental health of those around them, including family members, friends and neighbors.
Ali’s clients are also passing along their coping skills to others. One client noticed a roommate was anxious and suggested that they color together because coloring had previously helped the client manage stress.
Some of Ali’s other clients have been modeling the coping and communication skills they learned in counseling for their children at home. This includes using “I” statements, taking breaks and practicing self-care.
Ali also found a way to use her expertise to serve her community. Ali noticed a pattern of heightened stress among people in her life (herself included) because of the pandemic, but as a counselor, she also knew that this reaction was normal. She realized, however, that others in her community might not understand the emotions they were experiencing or know how to cope with the increased stress.
“This [pandemic] is not just exacerbating mental health concerns for people who are in counseling. This is also highlighting mental health problems for people who are not in counseling,” she says.
Of course, Ali couldn’t provide counseling to her entire community, so she and two other LMHCs, Candice Conroy and Sanya Matani, started offering a free virtual lesson to help people better understand and cope with the stress they might be experiencing because of COVID-19. The three LMHCs made it clear that the lesson wasn’t a substitute for counseling and provided resources for people to seek professional help.
Coping as a counselor
Haynes and Muratori express concerns about the stress levels counselors might experience throughout the pandemic and even after the initial threat subsides. “They need to take care of themselves better than they ever have before,” insists Haynes, author of Take Control of Life’s Crises Today! A Practical Guide.
Counselors need to apply the same coping strategies and tools to themselves that they give to clients, Haynes says. These include getting proper sleep, exercising, connecting with others, taking breaks, processing their emotions, turning off the news and getting outside.
Ali acknowledges that she has been feeling the stress of handling her own anxieties and concerns about the pandemic while also maintaining her current caseload. At first, the pandemic was the main topic for all of her clients, but this is evolving, she says. Now that most of her clients have adjusted to a new routine, they are again discussing their primary concerns that originally brought them to counseling. Still, Ali thinks it is important to do a quick check-in with her clients about how they are coping with the ongoing stress of COVID-19.
Self-care becomes even more important for counselors when sessions all deal with the same topic, giving clinicians few breaks to escape from it, Ali says. She has been coping with her stress by journaling, doing yoga, dancing, walking her dog, practicing mindfulness, reading, doing video chats and exercising.
Counselors need to remember that they are affected (whether directly or indirectly) by this pandemic too. Before the pandemic, most of Ali’s clients used traditional counseling, but with physical distancing rules in place, they now mainly use telebehavioral health. Ali acknowledges that staring at a screen for long periods of time has been taxing for her.
Taking breaks from the screen and using a semistructured schedule for both her personal and work schedules have been helpful coping strategies for her. When she feels particularly overwhelmed, she also practices a “digital detox,” putting her digital devices away for a day and focusing on her self-care to find her equilibrium. If a complete digital detox seems intimidating to counselors or clients, she encourages them to create small, manageable digital boundaries such as stepping away from their devices for a few hours or setting a timer to minimize their use of electronics.
For counselors in private practice, isolation can be another pronounced risk during the pandemic, Haynes points out. He highly recommends that counselors seek out colleagues for consultation, support and supervision during this stressful time.
Much like counselors advise their clients to look for individual and community strengths, clinicians can listen for examples of clients’ resilience, Dailey says. This may result in vicarious resilience, a concept developed by Pilar Hernandez-Wolfe, David Gangsei and David Engstrom in which therapists experience their own personal growth by witnessing and recognizing the growth of their clients.
Adjusting to a new normal
Even after the number of COVID-19 cases subsides, life won’t just go back to normal. The reentry process is going to upset people’s routines all over again, Haynes predicts. For that reason, he and Muratori advise that counselors prepare to take a more directive stance with some clients and focus on their life skills during the transition back toward a “new normal.”
Counselors may need to provide clients with guidelines, instructions or demonstrations, or they may have to model or teach clients new skills, Haynes and Muratori say. For instance, some clients who have been laid off may need help filing for unemployment, conducting a job search or applying for new jobs. Others may need guidance on how to safely reenter their workplace or physically interact with family, friends and community members for the first time in months.
Counselors will also have to help clients manage expectations, Dailey says. For example, many clients may now be dreaming of returning to work, but when that finally happens, they could very well find themselves stuck in meetings again and wondering what their kids are doing at home. Likewise, parents feeling impatient about their children returning to school may have forgotten what the old morning struggle was like to get everyone off to school and work on time.
Adjusting back to something resembling the previously normal routine as stay-at-home orders are lifted will take time. Dailey thinks the adjustment will come in phases. People returning to work will be one round of adjustments. Then there will be another adjustment period as schools attempt to reopen in the fall.
It is also important to note that clients won’t just be going back to “work as normal,” Dailey says. Even if they return to the same job and the same physical work location, things promise to be different in the wake of COVID-19. These differences may cause some clients to feel relief, whereas others will experience a new round of anxiety and fear.
Dailey compares these adjustment phases to a flipbook. Everybody has their own unique story with the pandemic, and every page of the flipbook represents a new experience, a new adjustment. Counselors can help clients process and cope with these adjustments by “flipping” through their stories, stopping at certain points, and assessing how the clients reacted and coped with that part of their story. The tools they used to cope — making art, meditating, sewing, exercising — are ones they can use again in the future as they adjust to a new phase, Dailey says.
The COVID-19 pandemic possesses the potential to change the counseling field and how professional counselors work with clients now and in the future, Haynes says. Since the turn of the century, it’s true that the United States has experienced major crises such as 9/11, large-scale natural disasters and the Great Recession, but, as Haynes points out, there hadn’t been a crisis on a global scale like a world war until COVID-19. This experience could shift the focus more toward prevention and preparation (both for individuals and for systems on a national level) for future crises, he says.
Adjusting to this new normal doesn’t have to be all negative. Once we reenter society after the threat of COVID-19 subsides, we will be able to celebrate regaining some of our old coping strategies as well as the acquisition or discovery of new strengths along the way.
Counselors are in position to help clients gain greater perspective and self-awareness while coping with the stress and loss that the pandemic has introduced, Ali says. To aid in that process, she sometimes asks clients who have already adjusted and are successfully coping with this stress and loss, “What are you learning during this time?”
In asking that question, Ali has found that several of her clients now understand how the coping skills they previously learned in counseling have helped them handle this stressful moment in history.
How we cope with the stressors of COVID-19 can tell us a lot about ourselves, Ali says. While it may be unpleasant, we can use these times as learned lessons that will help us continue to adapt and manage stressors in the future.
But for now, just take a deep breath.