Counseling’s evolution under COVID-19

Under a shelter-in-place order, are professional counselors considered essential workers?

What if a client’s insurance covers in-person therapy but doesn’t cover video or telephone sessions?

Are Skype, WhatsApp or Zoom compliant with health privacy laws?

My employer expects me to continue seeing clients in person, but I’m not comfortable with the health risk that entails. What can I do?

This spring, worried practitioners flooded the American Counseling Association’s on-staff ethics specialists with these and many, many other questions as the new coronavirus that causes COVID-19 gradually became a concern and then — very rapidly — upended the landscape of daily living across the United States. The past three-plus months have presented a steep learning curve for professional counselors, especially with the pandemic causing disruptions and difficulties with something at the heart of their work: connecting with people.

In addition to those challenges, the economy took a dramatic downturn, causing many counselors to wrestle with financial worries and even job uncertainty. Despite the widely reported rise in mental health concerns connected to or exacerbated by the COVID-19 pandemic, some counselors are facing income loss because of a decrease in clients. That’s due in part to many clients experiencing financial struggles of their own, including loss of insurance. Many counselors in clinical settings responded to these new realities by ceasing in-person interactions and quickly getting up to speed to offer client sessions via telebehavioral health. Most school counselors and counselor educators found themselves negotiating unplanned extended breaks or even abrupt halts to their school years in early spring. Many of these professionals navigated a similar scramble to that of their clinical counseling colleagues, having to adopt and use new technologies so they could continue supporting and teaching students online.

Under the strain of adjusting to this new normal, counselors say they have experienced a flood of emotions, from stress, worry and fear to vulnerability and frustration. At the same time, professional counselors are finding silver linings, such as learning the heights of their own strength and flexibility.

“It’s exhausting,” acknowledges Andrea Morganstein, a licensed professional counselor (LPC) and owner of a solo private practice in West Chester, Pennsylvania. When interviewed in mid-April, she had shifted her entire client caseload to sessions via telebehavioral health. “It’s been a constant evolution,” she says.

Morganstein says she has been relying on the support of her professional peer consulting group, which has been meeting virtually more frequently throughout the spring. In addition, she says her new self-care routine of taking a walk every morning at 7 helps her to anchor her day and maintain a stable schedule, including observing regular mealtimes and bedtime.

“I’m not scared of the virus. I try to take the approach that if there’s nothing to worry about right now, there’s no productive reason to take on extra worry. [But] at times, I’m not feeling good about myself and getting down on myself about not being able to manage everything and get enough work done,” she says. “I’ve learned about how much I was taking for granted in terms of the day-to-day social contact that I had [before the pandemic] and that it’s so important that it’s worth putting in the extra energy that is needed now to maintain those relationships and feelings of connection.”

As this article was being written in April, there were still many questions about how COVID-19 might affect the counseling profession over the long run. Will counselors rush back to offer in-person sessions as soon as possible — and will clients rush back to schedule them — after becoming more comfortable with online therapy? Will some of the emergency measures that offered flexibility regarding regulation of telebehavioral health spur change for the future? Will a mental health pandemic follow the COVID-19 pandemic as some experts predict?

Only time will tell. In the meantime, professional counselors will continue to do what they do best: supporting their clients and students, regardless of setting or circumstance.

Navigating the learning curve

Morganstein had set up the office at her practice so that she and the client sat perpendicular to each other during sessions. The comfort of that arrangement went missing when Morganstein shifted to offering sessions exclusively via video and phone in mid-March.

In addition to learning and adjusting to the technical piece of telebehavioral health, including a new web camera that initially caused extreme frustration, the medium forced Morganstein  and her clients to be “eyeball to eyeball” for video sessions. Some of her clients who struggle with self-esteem also expressed discomfort at seeing themselves for the duration of their sessions in the little video box in the corner of the screen.

When sitting with clients in her office, Morganstein often uses her own body language and positioning to help clients feel more comfortable during moments of silence or when struggling with difficult emotions. That subtle strategy is harder to deploy with telebehavioral health sessions. Although, as time has gone on, Morganstein has adjusted to sit farther away from the camera to bring more emphasis to her upper-body language and less to her face, she says.

“The biggest thing for me has been the use of silence. I have been finding that sitting in silence in telehealth feels different — more anxious and less comfortable for me,” says Morganstein, a member of ACA. “In exploring that, I realized when there’s silence on a video or phone call in the social realm, it’s a cue to say goodbye; we’ve said all we need to. But in therapy, I will often use silence to give the client space to think or process [a question or topic] or think through a new idea that’s coming to them. You can see it in their body language, that they’re ‘getting it’ and seeing a concept. It’s much harder, in my experience anyway, to do that in telehealth.”

“I’m finding instead that in my own internal experience with telehealth, my brain is telling me that I should be doing something — I should be keeping this conversation going and doing something to fill this space. It shifts the role that I typically inhabit in counseling,” Morganstein continues. “At some point, I do think it would be helpful to put it on the table and say [to the client], ‘Gosh, this feels different. Here’s a time that I would [normally] sit here quietly and let you think. What is this feeling like for you?’”

Morganstein says she is trying to stay mindful that as different as this new normal feels for her, it feels just as different for her clients. As the weeks pass, she continues to look for ways to shift her approach and re-create the warmth and openness she strives for during in-person sessions.

She lives in a townhouse with her spouse and children, so she has set up a section of her bedroom to conduct video therapy sessions. She has staged a section of wall to mimic an office setting, complete with a plant, a lamp and a canvas print. “I refer to it as ‘my home office’ to my clients. But it’s my bedroom, and I can’t leave confidential files lying around. That’s the part I’m finding very stressful,” Morganstein says.

Morganstein says the shift to telebehavioral health has also caused her to adjust the methods she uses with clients. In person, she often writes on a whiteboard in her office during sessions to illustrate a topic. “I find that [now] I am encouraging my clients to do a little bit of [in-session] journaling themselves, when normally I wouldn’t have slowed down to have them do it,” Morganstein says. “I’m finding it to be powerful and will bring it more into my in-person work. … I’ve learned that I should have clients write things down more on their own, in their [own] words. At the end of the session, they’re more likely to internalize what we just talked about when their brain had to do the work to construct it and put it on paper.”

On the minus side of the ledger, Morganstein says the exposure component of the social skills work she does with clients with attention-deficit/hyperactivity disorder has “ground to a halt” because clients aren’t leaving their homes. She is also finding that in-depth counseling work such as processing trauma is being put on hold because clients need to focus on more immediate needs such as dealing with the stress of going to the grocery store or, for school-age clients, mourning the loss of school activities and graduation celebrations.

“Doing trauma work temporarily leaves clients more vulnerable,” Morganstein points out. “Now is not the time to leave people feeling more vulnerable or emotionally exhausted.”

Morganstein also believes some clients have taken her off of a pedestal after watching her operate outside of her typical office environment — and she is comfortable with that. Seeing her struggle with technology at times or hearing her dog bark occasionally during sessions has allowed more opportunities for her clients to see her in a new light. “It’s OK to be human with your clients,” she stresses.

Morganstein recalls one session — or rather, an attempted session — scheduled with a middle school-age client in the early weeks after switching to telebehavioral health. Morganstein had sent the client’s mother a link to connect on the video platform she uses. When it came time for the session, Morganstein couldn’t get either the microphone or camera on her computer to work. She knew she needed help from her husband — “my IT guy,” she jokes — but counseling ethics regarding confidentiality dictated that her husband should not see the client, who was visible on the video feed. The client’s mother offered suggestions, staying online with Morganstein as she tried to problem-solve, but after 25 minutes, Morganstein gave up and ended up rescheduling the session.

What could have been a frustrating or angering situation for both parties actually ended up improving Morganstein’s relationship with her young client’s mother. The client was relatively new to Morganstein’s practice, and before this incident, the mother had been a little nervous and somewhat guarded around Morganstein. After witnessing Morganstein in a vulnerable situation, the mother seemed to feel much more comfortable around her, even making the occasional joke, and their relationship has grown since that time, Morganstein reports.

Practicing what you preach

Licensed mental health counselor Stacey Brown closed her Fort Myers, Florida, group counseling practice and began offering client sessions via phone and video on March 13, well before many practitioners in her area were doing so. It was becoming clear to Brown how easily the COVID-19 virus could spread, and knowing the number of clients who came through her office in an average week, she followed her gut instincts that Friday and made an impromptu decision to cease in-person sessions. “It just felt like the right thing to do,” Brown recalls.

Since then, Brown has been able to keep a full schedule of client sessions while working from home. She has found that a majority of her clients prefer telephone sessions. To retain focus during sessions and maintain some privacy from family members or others with whom they live, Brown’s clients have talked to her while sitting in a parked car, taking a walk or even floating on a raft in a backyard pool.

“All of my clients’ [presenting] issues are still happening, so they need support — or need even more. When people are forced to be by themselves, they have to deal with themselves. A lot of our talk [in sessions] has been on how to deal with ourselves,” Brown says. “For me, when you’re with somebody [a client in session], you need to really be with somebody. You need to be 100 percent present. You can’t go into a session with preconceived notions. That really messes you up. You can’t go into a session and think, ‘Today we’re going to talk about her mother.’ … Over the phone, it’s the same — sitting and really listening and concentrating. I really feel like I can be right there with them, and it’s turning out OK.”

Client struggles with anxiety, trauma and grief have intensified since the outbreak of the new coronavirus, says Brown, a clinical supervisor and ACA member. In addition to using cognitive behavior therapy and other methods, Brown has found it helpful to emphasize calming techniques such as breath work and meditation with clients. She has also ramped up conversations and check-ins about how well clients are sleeping, engaging in self-care, staying hydrated and eating — some of the foundations of Maslow’s hierarchy of human needs.

Wellness practices can help counselors and clients alike process and digest emotions, just as the body digests food, Brown says. “Now is not the time to do just counseling or just therapy,” she says. “Ask your clients if they’re having neck and shoulder pain, or how are they sleeping and what are they eating. Everyone is ramped up right now, and we need to take care of our bodies. Talk about stretches and relieving tension and the difference between shallow breathing and deep breathing. Remember the mind-body connection.”

As the pandemic continues to affect counselors’ work, Brown emphasizes that practitioners — now more than ever — need to heed the guidance they give their own clients: Don’t forget the importance of self-care, and find ways to move away from rigid and one-dimensional thinking.

“If we’re upset because things aren’t the way they are supposed to be, we will only get madder and more closed off. See this change as an opportunity, a chance to be creative and flexible,” she says. “You have to nurture yourself and find balance. This includes turning off the news, if needed. Take the same advice you give your clients [to] be aware when your anxiety is rising.”

Likewise, counselors often encourage clients to be intentional about their life choices and the goals they set. The same guidance applies to practitioners themselves, especially during times of crisis, Brown asserts. Brown, who is certified to teach yoga and meditation, has found ways to diversify her work and supplement her income from counseling. In addition to offering meditation and yoga instruction, she paints and sells her artwork, writes, and supervises counselors-in-training.

From Brown’s perspective, the business side of counseling is a lot like a tennis match. When your opponent is about to serve you the ball in tennis, she explains, you don’t know where it will go, so you have to be agile and “springy” in order to run and meet the ball. So too with running a business: You have to think ahead and be both prepared and flexible when challenges arise.

“Counselors can’t just sit in their office and see people anymore; they need to diversify and have multiple income streams. We can’t just be awesome clinicians; we have to be awesome business people as well,” she says. “We have to practice what we preach — and this is the challenge, always. If you’re constantly in the box, then that’s where you’re going to stay. … If you’re always reactive, then you’re going to have some trouble with your business. If you’re intentional and manifest what you want, then you’ll be fine.”

Professionally, Brown says these past few months have presented her with lessons in creativity, patience, gratitude and self-trust. Even though she loves her office setting, she is thinking of continuing to offer telebehavioral health from home one day per week after the COVID-19 pandemic subsides.

“This has given me time for self-examination and time to reflect and confer with others on how they’re running their businesses,” Brown says. “Aside from the health fears, it has been a rejuvenating time for me because of the creativity element. When I was in the office, I was all zoomed in on day-to-day activities. Now I have been able to zoom out and see things from the big[ger] picture. It’s different somehow. … It’s helping me to refresh my perspective and stay curious on how to do this and how to grow my business to be sustainable to attain my ultimate goal: to help people.”

Emphasizing safety

Linda Diaz-Murphy has been doing play therapy with young clients via telebehavioral health ever since New Jersey enacted a shelter-in-place order in March. Parents and youngsters alike have easily adapted to the medium, she says. A parent or caregiver is always present during the session, and young clients use a combination of their own toys and play therapy items such as sand trays that Diaz-Murphy previously sent home with families.

Even when delivered via telebehavioral health, Diaz-Murphy says, the focus of play therapy remains the same: building clients’ sense of safety and developing their coping skills and strategies. This includes talking about and processing emotions as young clients draw or create scenes with figurines.

“We use whatever resources they have,” says Diaz-Murphy, an LPC and registered play therapist whose private practice in Leonia, New Jersey, is 15 minutes away from the George Washington Bridge leading into and out of New York City. “One child likes to cook [using a play kitchen] and feed everyone in his family. We used to do that in the office, and now we’re doing that in teletherapy. We’re continuing to do the same things in the home as we do in the office, which is really amazing. Nothing has really changed except the location.”

Diaz-Murphy has also been emphasizing safety with her adult clients in the form of extra outreach. As soon as she switched to telebehavioral health, Diaz-Murphy increased her communication with clients, checking in regularly (once or twice per week) via phone or text message. She has let her entire caseload know that she is available for extra sessions or even “just to talk,” although she limits client phone calls outside of sessions to 30 minutes.

“It’s more than I would usually do, but this is important,” Diaz-Murphy says. “Years ago we called it proximity control, but it is just being there for [clients], helping them feel safe and know that you’re there to help.” It also involves staying close with and being available for clients without being too intrusive, she explains.

One of Diaz-Murphy’s clients, an adult man who lives alone and is geographically separated from his family, had a relative die of COVID-19 in April. Initially, he was hesitant to use telebehavioral health, but Diaz-Murphy continued to stay in touch with him via text message. Eventually, he agreed to participate in a counseling session over the telephone. Now they are in contact roughly twice per week, and the client is reaching out to her instead of the other way around, which Diaz-Murphy views as a very positive development.

“What is important for me, especially during this coronavirus crisis, is to always be honest [with clients], share my limitations, discuss options, think of safety first, be patient, offer reassurance, speak in hopeful tones and use hopeful language, remain in the present and think of the future, make myself available, and remember [that] my presence is important,” Diaz-Murphy says.

Diaz-Murphy has completed extensive training in disaster mental health and is a crisis response counselor. She has drawn on that knowledge this spring, she says, adjusting her approach to meet her clients’ needs as anxieties swelled and so much was unknown. Part of her own coping strategy during the pandemic has been to continue learning. She recently completed a training on offering disaster mental health and crisis counseling over the phone, including best practices on strategies and language to use.

A little humor can also go a long way when anxiety is swelling, Diaz-Murphy says. During the toilet paper buying frenzy (and ensuing shortage) that accompanied the first several weeks of COVID-19 in the United States, she found a website that calculated how much toilet paper each household would need to make it through quarantine. She shared the site with a few clients to lighten the mood.

“It’s a source of humor, but [there’s] also a reality that people are afraid that others will take resources and there won’t be enough left. It’s the same with food. This [toilet paper calculator] puts things into perspective for people, and then it helps in other ways,” says Diaz-Murphy, a member of ACA.

Most of all, she has focused on making sure her clients have appropriate self-care and coping mechanisms in place to deal with the worry and uncertainty that have accompanied the pandemic.

In times of crisis, professional counselors must remember to trust themselves and fall back on their core counseling skills: empathy, communication and listening. “You want [clients] to be in control and feel empowered,” she says. “Behave the same way that you would in the office: Don’t panic, stay calm, and treat your clients with respect. Let them know that they can manage this, and give them the tools to manage.”

Finding connection on camera

Chris McClure still drives to her Manassas, Virginia, private practice to conduct telebehavioral health sessions, even though clients are no longer coming in. Sitting in the same chair and being in the same space where she used to conduct in-person counseling helps her to focus and “switch gears” from the personal to the professional, says McClure, an LPC and a member of ACA.

She also thinks it is important to retain that familiar setting for her clients. When Counseling Today interviewed her in April, McClure was working to set up her laptop so that clients would see her at the same angle and with the same backdrop as if they were sitting in the client chair in her office.

She admits that she is still struggling to strike the right balance while using telebehavioral health. Initially, she felt too detached and too “pulled away” from clients through video. Sometimes she feels that she has to “project my empathy larger than life” to get through to clients.

“Video doesn’t feel very intimate, and therapy is a very intimate interaction,” McClure says. “It can be kind of intrusive. I am coming into a client’s home, and some are uncomfortable with that.”

McClure also tries to use her facial expressions to connect more with clients. The human brain is hard-wired to recognize emotions in others’ faces, so clients can pick up subtle cues, she says. “If they can see us looking reasonably calm and conveying very soothing messages, then they are better able to handle their anxiety,” she says.

When clients express discomfort about using video for counseling sessions, such as remarking that their home is messy or apologizing for family members who wander into the screen, McClure acknowledges that adjusting to the new medium is hard. To further validate their feelings and set clients at ease, she sometimes remarks that it would be difficult for her to “let someone in” to her home and that she is grateful for their hospitality. Complimenting something that she sees on camera, such as a pet or a piece of art on the wall, can also help, she notes. With clients who still seem a little uncomfortable, McClure revisits the topic in future sessions to help them continue to adjust.

“For most clients, after a time, they forget that they’re not in the office and just focus on me. Others are more aware of the limitations of it,” McClure says. “I’m very much a perfectionist and very much a caretaker, and I want this to be as comfortable and smooth for clients as possible. I’m very much aware when things are missing. [But] I do think that it’s possible to get there with this technology.”

One particular challenge McClure has noted while using telebehavioral health is picking up on clients’ nonverbal cues — something she says comes as second nature to her in person. Recently, she was conducting a session with a client, and the image quality and delay of the video feed made it difficult for McClure to recognize that the client was on the verge of crying until tears were streaming down his face.

“I’m working overtime to listen for those subtle cues in their voice. After almost 30 years [as a counselor], a lot of that is second nature, autopilot, and [now] I have to bring that up to a more conscious level of listening,” she says. “When you’re together with a [client], you can notice the slightest twitch of an eyelid or small facial movements that can convey so much, especially when people are trying to hide their emotions.”

At the same time, McClure acknowledges that her clients are expressing more basic needs right now, such as managing anxiety and getting enough sleep, which aren’t as dependent on nonverbal cues, or at least not at such a deep level as other counseling topics might involve. “It would be exaggerating to say that people are regressing [in therapy], but there is some truth to that. Some of what I’m doing is crisis management,” McClure says.

So much has felt like a moving target as the COVID-19 pandemic continues to unfold and new information becomes available, McClure notes. She has been trying to find a balance between staying informed and limiting her exposure to the news.

“I see a lot of [clients] with anxiety, and I’m trained to help them with [distinguishing between] rational fears and irrational fears, and it’s been very unclear between those two. I have some people who are absolutely terrified and don’t want to leave their homes, and others who think we’re overreacting. It’s hard to feel like I, as a counselor, have an authoritative message when there’s so much mixed information out there. … I think the vast majority of Americans are feeling a considerable amount of anxiety. This [virus] is a substantial threat to our way of life, our well-being, both health and economic.”

McClure has completed a number of trainings on telebehavioral health over the course of her career, although she didn’t use it much until the COVID-19 pandemic hit. She plans to seek more continuing education to keep adjusting to the medium. Eventually, she’d like to transition to semiretirement and be able to counsel clients via telebehavioral health while traveling.

“I’m excited by the possibility that a lot more people are going to get comfortable and used to [telebehavioral health],” McClure says. “Part of the reason I’ve been interested in distance counseling is that there are a lot of underserved populations [that could benefit]. I specialize in working with transgender clients and clients with gender concerns, and there are not that many practitioners who are genuinely trained and qualified to work with these clients once you’re past major cities. There are huge parts of [my] state that are just not well served on certain issues. I really like the idea that a client could get really quality therapy, even if there’s not a therapist within 50 miles. … Hopefully some of the temporary things that have happened during this [pandemic] will stay in place and [result in] positive change.”

‘We’re stronger than we think’

Celine Monif has a private practice near the junction of two states, Iowa and Nebraska, that have not enacted shelter-in-place orders. That has created a sticky situation, Monif says, because she can only suggest telebehavioral health and encourage her clients to use it. The other option would be to voluntarily close her office, but Monif is unwilling to do that because it would disrupt or suspend treatment for clients who are unable to use telebehavioral health. For those who opt to continue with in-person sessions, she has been seeing clients at her Bellevue, Nebraska, office, spacing out sessions so that no two clients cross paths and risk infecting each other.

“It’s been a heavy mix of demand and resistance to go to telehealth, which would not happen in a shelter-in-place state,” Monif says. “Some [clients] are coming in because this is their safe space, and they don’t feel they would get the [needed] privacy or freedom to talk freely at home.”

Monif, an ACA member, holds two licenses. She is a licensed mental health practitioner in Nebraska and a licensed mental health counselor in Iowa. She estimates that roughly one-third of her caseload continues to come in for in-person sessions. Some of these clients simply aren’t comfortable with telebehavioral health technology. For others, it poses logistical challenges. For example, one of Monif’s teenage clients continues to come to the office for in-person sessions because she doesn’t have a cell phone of her own and her large family has only one computer to share between them.

To minimize the risk of infection, Monif has been sanitizing her office and waiting room after every client, taking her temperature each morning, washing her hands regularly, and opening the door for each client so they don’t have to touch the doorknob. She has also posted a sign on her office door asking that people who are sick or have a fever not enter.

Monif admits that she has experienced a roller coaster of emotions this spring. “Because it’s the Midwest and we’re not the epicenter of the virus, we still have a percentage of people who are not taking this as seriously as they probably need to. This can be frustrating,” she says. “But at same time, there’s compassion. I understand about their fears or hesitancy to give up the safe space of my office. I understand the anxiety and feel a lot of compassion for them. … My emotions fluctuate so quickly throughout the day.”

In the past, Monif typically accommodated one or two pro bono clients at any given time to help those who couldn’t afford counseling or had lost their insurance coverage. With the recent economic downturn in the wake of COVID-19, that number has increased, with Monif offering pro bono sessions for several clients who have lost jobs or been furloughed.

“It would be unethical for me to stop [treatment] and not try and help them,” she says. “My husband and I are both working and will be OK for the near future. We have that luxury, so I will continue [to offer pro bono services].”

A trained volunteer for Nebraska’s Critical Incident Stress Management program, a statewide team that offers mental health debriefing for first responders after major incidents, Monif is also offering free sessions for first responders who need counseling.

The counseling profession’s swift and unexpected pivot to telebehavioral health this spring has revealed a few challenges that will need to be addressed for the long term. For example, there have been mixed messages concerning which telebehavioral health platforms are compliant with health privacy laws. Professional counselors need clearer guidelines both from licensing boards and insurance companies, Monif says.

“[Practitioners] in my area often have clients across state lines, and there’s some confusion on what our license allows. It’s a new territory,” Monif says. “When everything comes out, we’re going to have a little bit to unravel. … It used to be that online therapists were a specialty, and now it will be more of the norm. There will be a huge influx of providers who provide online therapy.”

“If there’s a silver lining to this,” she continues, “I’m hoping this helps raise the awareness that this [telebehavioral health] is something we need. It’s an essential service. People need access, and right now it’s an imperfect system, and we need to work on it.”

The fallout from COVID-19 has ushered in an opportunity (even if unwanted) to learn and see things from a new perspective, Monif says. She has witnessed counselors in her area rise to the occasion and rearrange their entire practice to work online, all while caring for family and dealing with both the personal and professional stressors of the coronavirus pandemic.

“I have learned that if I have to adjust quickly, I can,” Monif says. “I went from having zero telehealth clients to [those clients being a major] part of my caseload in seven days. I learned that we’re all in the same boat and we don’t have the answers, but we’re learning as we go. This threw us all off-kilter, and we’re still day by day, [but] we’re all so adaptable, and that’s great to see. … We’re stronger than we think, [but] we also need to make sure we’re taking care of ourselves. Find a balance between managing your own emotions, taking care of family, and being responsible for clients and helping them. Find that balance, and you’ll be OK.”

Identifying potential in crisis

Although the COVID-19 pandemic has forced some unexpected changes to the way professional counselors are working, it has also brought immense potential for practitioners to flex their outreach and advocacy muscles, says David E. Jones, an LPC in the Cincinnati area.

Counselors are well suited to help with the many needs that have arisen alongside COVID-19, from the anxiety and isolation that can accompany shelter-in-place mandates to the distress and burnout felt among health care workers and first responders, says Jones, an ACA member and assistant professor in the Department of Counselor Education and Family Studies at Liberty University.

“There is a chance of having a mental health pandemic after all of this. What are we [counselors] doing? What can we do? What should we do to help our communities? What are we going to do six months from now, beyond just our individual clients?” asks Jones. “Part of this is getting outside our walls of one-on-one thinking and coming together as a profession and collaborating across professions to address at-risk populations and structural disparities. We need to be collaborating with public officials and sitting at those tables for long-term planning and thinking of the mental health aftermath.”

Jones urges counselors to take their role as advocates seriously and to think about how they can reach across disciplines to address mental health in their communities. This could include collaborating with local organizations, schools and even houses of worship, but it should involve thinking outside the four walls of the counseling office, he emphasizes.

“Show up at town hall meetings or sit down with local politicians. Offer to go to your local firehouse and talk about mental health first aid. Or send them a letter and offer to have coffee with them and offer your insights,” suggests Jones, who was a public health researcher, including time spent as an infectious disease epidemiologist, before switching careers to become a professional counselor. “It doesn’t have to be a huge elaborate thing, but it’s a drop of water in a pond, and if you have a lot of people putting a drop of water in, it’s going to ripple and make a difference.”

For example, there will be immense need for career and employment counseling in the coming months, with millions of Americans being unemployed or underemployed. Counselors could host community workshops focused on learning job search and interview skills, seeking job training or studying for the General Educational Development exam.

“Counselors have so many points of contact to make a difference, [including] schools, parents and other nonprofits. Who do you know that could make a difference? Go and speak at groups, provide psychoeducation [about mental health], and shine light on local resources. We need to get out of our silos and work across professions. There’s connection points that can be made, and sometimes you just have to think outside the box to make them.”

In the wake of the coronavirus crisis, there is great potential to expand the counseling profession’s reach and impact while meeting needs in counselors’ communities, Jones stresses.

“During a time like this, we get a chance to reflect on who we are. And that’s a good time to make us pause and look at things that are working, and things that aren’t working, and have a potential place to effect change,” Jones says. “You can focus on the distressing part of this, or you can introduce yourself to fellow counselors in town and ask if they need anything. It’s time to reflect and be more person-centered than we were before.”

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Professional resources

• Telebehavioral health is referred to as “distance counseling” in the 2014 ACA Code of Ethics. Find out more about the limits and nuances of this medium in the ethics code at counseling.org/knowledge-center/ethics/code-of-ethics-resources.
• Visit the ACA website, counseling.org, for the latest information and a wealth of professional resources related to COVID-19, counseling and telebehavioral health, including continuing education offerings.
• Visit CT Online, ct.counseling.org, for a variety of articles on topics related to COVID-19, including talking to children about the coronavirus and helping domestic violence clients during shelter-in-place situations.

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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.