This month marks two years since the World Health Organization (WHO) declared the outbreak of the SARS-CoV-2 virus, more commonly known as COVID-19, a pandemic. At the time, there were more than 118,000 recognized cases of the coronavirus in 114 countries and just under 4,300 deaths attributed to it. Those numbers have now climbed to more than 430 million confirmed cases and close to 6 million deaths worldwide.

“Pandemic is not a word to use lightly or carelessly,” said WHO Director-General Tedros Adhanom Ghebreyesus in his March 11, 2020, announcement. “This is not just a public health crisis, it is a crisis that will touch every sector — so every sector and every individual must be involved in the fight. … Let’s all look out for each other, because we need each other.”

His prediction that the virus would touch “every sector” has proved true for the counseling profession. Counselors have met challenge after challenge brought on by the pandemic, including adopting and adapting to telebehavioral health, supporting clients’ and students’ shifting needs and managing overbooked caseloads as a surge of new clients sought help. In addition to these professional challenges, clinicians have had to attend to other needs in their personal lives such as caring for family members or recovering from the virus themselves. 

The past two years have demanded creativity, advocacy, flexibility, compassion and a seemingly endless list of other qualities from counselors. And for all counselors, it has been a learning experience. Counseling Today recently contacted an assortment of professional counselors from around the country to ask what the pandemic has taught them. In this article, they share their reflections and their lessons learned in their own words.

 

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It takes a lot to be a person today.

There have been times over the past few years when I’ve wondered: Who am I to be sitting in the therapist chair? When I decided to become a counselor, I never expected to live and work through a global pandemic. COVID-19 has left me feeling vulnerable and grateful, with many other emotions pulsing within me at various times. As I’ve heard others exclaim quite passionately these past few years, “This was not on my vision board!”

As a therapist, I believe the most important aspect of my job is to simply hold space for others. Holding space implies creating a safe platform between individuals that fosters empathy, compassion and healing. It says that each person welcomed into the dialogue is so incredibly special that time is invited to stand still while they process life together. Therapeutically, holding space empowers a client with the opportunity to feel all of their feels and process life experience(s) with empowerment and confidence.

Today, I find both myself and my clients collectively sharing the same trauma. A global pandemic impacts each of us on every level of our experience, from our basic needs to existential thoughts of “Why are we here?” and “How did this even happen?”

Sometimes I feel like we’re in this strange paradigm of history and science fiction colliding into our actual experience. Despite our global situation, all of our individual anxieties and fears still exist as life continues to flow, even during worldwide crises. It takes effort to separate the individual from the collective experiences, as life is truly merging on every level, from how we work and go to school to how we communicate with our peers at our most intimate levels.

There has never been a time when I have needed to be more present and honest with my own vulnerabilities, both personally and professionally. While holding space for others, I have often felt safe being held in the space of my clients. We are walking each other through these uncertain times, and I am grateful for the many hands I have held and [for] those who have
held mine.

— Jen Monika McCurdy is a licensed professional counselor (LPC) in St. Louis who owns and operates a private practice, JM Wellness. Her passion is to empower her clients to live the life they most wish to live.

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I remember sitting at home as a new mom holding my baby as the world shut down and COVID-19 changed everything. Nobody knew what to expect, but it was the beginning of a collective experience that has forever changed us.

We have been forced to grieve unimaginable losses, change many plans and accept our lack of control at the same time as we suffered other hardships like job losses, closed schools and being unable to visit relatives. Clients who already felt behind in the relationship world had to grapple with an extended break from dating.

Simple decisions, like spending time with family or friends, were suddenly filled with complexity. At times we thought we were safe, excited to drop our fear and feel more normal, and then a new variant or surge hit. We have learned to pause more, not take things for granted and recalibrate our expectations.

In the past as a counselor and coach, I’ve related to my clients and their experiences, but through COVID-19, we were all experiencing similar anxieties and hard decisions simultaneously. I’ve also had to adapt professionally and learn to put my own pandemic stress and anxiety aside to hold space for my clients.

There is something empowering about remembering we can adapt and be resilient; I believe we underestimate our ability to change. Somehow, through some very dark, isolating and scary moments, we have found our path. Pre-pandemic, we might not have believed we could, but we have confronted the illusion of control and learned to live with more ambiguity.

Professionally, I have grown to love working from my home office and speaking to clients from their homes. Many of my clients who used to be out and about 24/7 have soaked in the benefits of solitude. Through healthy self-care habits, creating structure and routine at home, and staying connected, we have all changed in ways we would have never predicted. Watching these lessons play out in therapy has allowed me to feel just as connected to my clients, even though it has been years since we have sat together in the same office.

Personally, although I grieve the lack of normalcy in my daughter’s early years, I will be forever grateful for the extra time we have had together.

— Rachel Dack is a licensed clinical professional counselor (LCPC) and dating and relationship coach who owns a private practice in Bethesda, Maryland, and specializes in dating and relationship issues and anxiety.

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The counseling world we once knew has been shaken by COVID-19 in ways no one could have imagined. Our routines, no matter our age or stage, have been shattered, and we’ve only ever been given the option to pick up and make sense of the pieces. The one thing that all healers and journey goers alike have in common is the uncertainty married to the pandemic, which doesn’t allow for normalization. “Normal” already had a loose definition to begin with, but COVID-19’s reign has shaken up every case of normalcy. Even with everything upside down, we’ve all been striving to find a new normal, and one thing we’ve learned from COVID-19 is to keep going.

The clients — journey goers and brave souls — were forced to face challenges alone, but they were able to hear and validate their own opinions in the process. People learned they could be their own biggest support system and how to really take care of themselves. With extra time placed in their laps, they learned that they deserve more.

In regard to clinicians, if anything, we’ve learned to focus on what matters. This pandemic forced a shift in our thinking and redirected our perspectives, but ultimately, we’ve become undeniably resilient. We’ve made meaning of struggles — our own and of others’ — and found a way to show up every day.

As far as me, I’ve learned to trust the process and honor not only the struggle but also the strength we’ve had no other option but to find. We don’t have to find a new normal when we can help to create it. I was able to fall in love with this profession all over again, but this time in a different shade of light.

And to my fellow colleagues and all healers alike, keep showing up. You are needed, you are valued, and you are necessary. With that said, make sure you’re saving some of that care, concern and love for yourself because you deserve it too.

To quote Maya Angelou, “You may not control all the events that happen to you, but you can decide not to be reduced by them.”

— Mykia Hollis-Griffith is an LPC, licensed marriage and family therapist associate (LMFT-A) and owner of a private practice, The Mindful Life Company, in Killeen, Texas.

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When the COVID-19 pandemic began, the world was overwhelmed with fear for themselves [and for] loved ones and fear of what was to come. All the while, mental health workers, doctors, nurses and other “essential” workers were dedicated to ensuring their needs were met. It was during this time that I learned the most about myself, my clients, the counseling profession and mental health overall.

Although I live and work in the small town of Erie, Pennsylvania, I realized that our struggles and fears were the same as the world’s struggles and fears. Living in a smaller town did not mean that I or my fellow Erieites were exempt from the issues plaguing the larger cities, but instead it meant that I could make a larger impact on the lives of those around me. I began to reflect on who I was professionally and what type of environment I wanted to provide to my clients, specifically those struggling with the weight of the pandemic.

I decided that I needed and wanted to provide a safe space for people to be who they are and to have open conversations about the pandemic, past traumas or other concerns. As my practice began to flourish, I noticed that people needed an outlet and found themselves at my office. Clients wanted to share, they wanted to feel better and, most importantly, they wanted
to grow.

I too wanted to grow. I found myself wondering if the counseling field was where I needed to be full time. As a professional counselor, witnessing the dedication shown by my clients was nothing short of amazing, particularly as the pandemic became scarier and more unpredictable.

It was then that my question was answered. I knew where I needed to devote all my professional time and why it was important to my growth as a person and a professional. The constantly changing landscape of the world due to the pandemic has forever changed how I view mental health. I have found that people are more honest about their struggles, more open to seeking help and more committed to themselves.

Throughout my counseling career, a major focus has been on helping clients build healthy, positive relationships [and] a foundation for the life they dream of, and grow into the person they want to become. The experience of counseling people through the COVID-19 pandemic has reaffirmed that my therapeutic approach is necessary and relevant.

— Chelsea Curlett is an LPC and has been the owner of a private practice in Erie, Pennsylvania, for six years.

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We found ourselves in over our heads without a view of what was ahead. The rapid change and uncertainty forced us to adapt.

The first lesson I learned during the pandemic was that crafting masks out of whatever material I had on hand was difficult but doable. I assembled the first COVID-19 masks for my family with the help of a dusty sewing machine. At first, there was only one mask per person, which was not sustainable since they needed daily washing for repeated use each day. As the pandemic deepened, the skills of those artisans who crafted and sold masks permitted us to order and obtain multiple masks custom-fitted for each person. I was grateful.

This creative connection to the people making the masks around the world set the stage for many of the lessons I learned [that were] continually reinforced during the pandemic.

All life centers around relationships and is impacted by connection, location, choice and privilege. Relationships that I reflected on during this time related to the human condition and the context in which shared human experiences exist. Consequently, my own experience has been informed by my relationship to myself and how I relate with others. All relationships occur in context.

This notion had me consider how I relate to the past, present and future — through experiences and expectations [and] within the context of what is known and unknown. Throughout this process, I embraced stillness, commotion, loss, gain, choice, understanding and peace.

Change is difficult, but like making masks with whatever scattered materials are available, it is doable. I encourage all to consider how you have changed and adapted and found ways to connect your relationships to meaning and purpose, goals and aspirations, grit and determination, hope and healing.

— Carrie B. Sanders, an assistant professor of counselor education at Radford University in Virginia, has a background in school counseling.

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I used to have a competition with myself on the drive home from my office. Cranking up the music, I’d dance in my car and tally how many other drivers I could get dancing when stopped at red lights. It was my way of shaking off the heaviness of the day. When COVID-19 hit and I got sick with it [the virus], I lost both my commute and the energy to dance.

When going through similar experiences as our clients, we need to take care of ourselves and our own reactions first. I know this is an obvious one, but I had to truly dig through this lesson in a different way during the first year of the pandemic. This past year, I completed my internal family systems Level 1 training. In learning to care for my own internal parts and helping clients to care for theirs, I gained a lightness that allowed me to better care for clients without carrying their burdens.

I continue to learn, repeatedly, how to say no in order to say yes. This means saying no to more work. Time off — and truly away from the responsibility of mental health care — is not just for fun; it’s a necessity. It also means setting boundaries. I sometimes need to say no to bids for my compassion by those outside my immediate circle in order to continue to say yes to my clients.

I continue to see fewer clients than I did pre-COVID, which I acknowledge is a privilege of working in private practice. To balance out the impact of my clinical load, I also prioritize other parts of my career, such as writing and freelance editing, and other nonclinical ways to share my expertise. 

Last week, I walked out my front door with my dog after closing my laptop, bundled up against the cold, dancing as I shook out the day. Whatever you do to shake out your day, I hope that you find a way to do it in the midst of the pandemic. And if you dance in your car or on your sidewalk after your final client today … let me know because my competition is back on.

— Johanna Bond is a licensed mental health counselor (LMHC) in private practice in Rochester, New York. She is also a writer with prior work appearing in The New York Times, HuffPost and Psychology Today.

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I have learned the importance of presence on a deeper level during the pandemic. Being able to show up during this time as an anchor for clients’ nervous systems has been a powerful tool. Utilizing coregulation and resonance has been pivotal in working with clients with trauma.

In order to show up more fully in this way even across digital platforms, I took a course on mindful awareness and resonance in eye movement desensitization and reprocessing (EMDR) and completed rapid resolution therapy training, both of which focus on the connection between the client and the therapist and working within that relationship to shift the client’s experience, even if it’s brief therapy. Although the two trainings are very different, they both rely heavily on therapeutic presence.

The theme of learning about presence also flows into my personal life, as I’m so grateful to the people in my life supporting me so that I can support others.

— Hillary Cook is an LCPC who owns and operates Idaho Trauma Therapy in Boise, Idaho.

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March 2020: A defining moment in our lives. There is before COVID-19 and after COVID-19. While there have certainly been other defining moments in our lifetime, none has lasted as long or affected as many individuals as this pandemic. The astonishing breadth, width and depth of this pandemic feels fictional — except that we are all living this collective trauma.

Having been a counselor and counselor educator for over 35 years, I felt competent to continue to assist my clients through this time. My basis for working is systemic, so incorporating an extended system did not seem difficult. I was wrong in many ways.

It seems to me that there were stages that we all went through during this time. Beginning in spring 2020, clients seemed to be optimistic about the length of time and severity of the virus. We continued to focus on the challenges they presented for counseling with a mention of the limitations that lockdowns, etc., were creating. However, some felt the isolation more than others.

The second stage, I believe, began around fall 2020. Schools were or were not reopening, work was still from home, [and] counseling was mainly on virtual platforms. A sense of frustration, fatigue and losing control of their environment began to appear in sessions. Many [clients] started with concerns about their external world — the pandemic, the political environment, climate changes. These challenges blended into their own personal work. In fact, in some cases, they overshadowed their personal issues. Feeling that they had no control over the world “outside” left some of them with an attitude of defeat.

The next stage came with the delta and omicron variants. My clients express not only frustration but [also] a sense of hopelessness in changing the world situation that is impacting each of us. This, of course, impacts the changes that are available for them in their personal choices. Lack of extended support, entertainment, travel and most interactions creates a loneliness that is nonrelated to their personal or relational challenges.

My professional journey has been somewhat the same as my clients’. I have learned to use virtual counseling, and while adequate, it lacks the connection of in-person work. I have dealt with the same feelings of frustration, isolation and lack of “normal” social interactions that support my sanity.

My work has become even more focused on mindfulness as well as other techniques and skills to quiet anxiety and relieve depression. Further[more], I endeavor to assist clients in understanding what they can control, what is beyond their control and how to advocate for what they deem worthy in order to make a difference, thereby gaining a sense of control.

— Patricia W. Stevens is an LPC and private practitioner in Louisville, Colorado, who is a clinical fellow of the American Association for Marriage and Family Therapy.

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As a professional counselor, I have learned how important connection truly is. Both in private practice and within a university setting, young adults fear loneliness more than the virus itself.

I never thought I would adjust to telehealth, but to my surprise, I felt connected to my clients. Connecting remotely, whether from a bathroom, basement, car or the client’s own bed, allows for a more vulnerable experience. The client isn’t coming to your office, but rather you are meeting them in their space. I have found that clients open up more readily when they are in their own space. Vulnerability breeds connection.

During this time, I am reminded of how much we need people rather than “stuff” to make us happy. It’s amazing how much active listening, eye contact and empathy can transfer online.

In nearly 20 years of experience, I am seeing loneliness and loss of motivation as top reasons young adults seek help. The pandemic is also intensifying symptoms of anxiety and depression. People want to see each other. In America, isolation is a punishment.

The best way to help clients is to encourage connection, but how do we do this in the midst of a pandemic where we are told to refrain from in-person social interactions? I have found that people are amazingly resilient and adept at connecting. Netflix movie dates, FaceTiming, online gaming groups, working remotely, virtual coffee breaks — it’s amazing how technology is helping us stay united.

Three years ago, after working in a university for 16 years, I decided to open up my own private practice. Six months later, the pandemic hit, and my appointments went from in-person to 100% virtual. I think I learned more in the last two years than I ever would have without being forced to go online. In a sense, I was learning and adapting with my clients. Shared experiences breed connection.

Life surprises us. I was surprised that I am able to connect and ignite change in clients who are not sitting right in front of me. I am humbled by the resilience I see in my clients and myself. My advice is to go into things with an open mind. You may be surprised at what you find.

— Nicole Lowry is an LPC with a private practice in Erie, Pennsylvania, and is the assistant director of the Personal Counseling Office at Penn State Behrend.  

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In these last two years, I have learned several valuable lessons, [the most important of which is that] telehealth can be a viable and accessible way to provide therapy. As a clinician practicing in a remote and rural part of the country, I valued the ability to provide flexible appointments to clients who often have systematic barriers that limit their access to counseling services. [This work has] reminded me of the importance of hope in managing life’s challenges and facilitating posttraumatic growth. It reoriented me and a lot of my clients toward appreciating the mundane and ordinary parts of life, which coincidentally were the most noticeably absent during the pandemic.

The analogy that “we are all in the same storm but not in the same boat” has been a valuable reminder regarding the differential impact of the COVID-19 pandemic throughout the global community. It emphasizes the diversity of outcomes within these collective experiences by reminding us that while we may all be in the middle of the same storm, we are impacted in a different way. Either we have a sailboat of skills and resources, a lifeboat of support, or we are out in the middle of the ocean with neither. During this time, I witnessed clients navigate challenges related to isolation, health, finances, child care, transportation, food, employment, education, racial disparities and mental health. I was often reminded about the importance of a strong therapeutic alliance and how it was nurtured and strengthened by the shared commiseration of dealing with uncertainty and the collective empathy of navigating existential fears while managing everyday stressors. 

While dealing with the mishaps and challenges of technology has required patience, telehealth has been invaluable in allowing me access to clients’ lives in ways I may never have been able to from the confines of my office. Some of my clients lacked resources to engage in sessions privately and would use their vehicles [for sessions]. Others — often younger clients — were more at ease in the virtual platform and enthusiastically shared their relief [of] not being in-person. I am grateful for those clients who invited me into aspects of their lives that are not often visible in a clinical office. Sharing virtual spaces required a vulnerability that further deepened my understanding of who they are as people.

As a BIPOC [Black, Indigenous and people of color] clinician, it is not unusual that I find myself managing the parallel experience of racial injustice with my clients. This became magnified during the pandemic and required me to lean toward social justice advocacy while also prioritizing radical self-care to continue providing ethical counseling services.

— Portia Allie-Turco is an LMHC and counselor educator in Plattsburgh, New York, who specializes in the treatment of historical, racial and complex trauma. 

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In April 2020, I was hospitalized for 11 days with COVID-19, pneumonia and sepsis. I sought advice from a colleague about what details to provide my patients, keeping in mind that their physical health was not at risk because of telehealth. She was shocked that this was my concern.

The next day, I was scheduled to present at a virtual conference. I called the organizer and gasped, two words at a time, that I could … still do … the presentation. Baffled, she forbade me, demanding I take care of myself. When I was discharged, I told patients I’d return to teletherapy the following Monday. Without exception, they said they wanted me to focus on my recovery.

I didn’t want to disappoint anyone and was committed to fulfilling my duties to my patients and colleagues. It took weeks to understand that I was the only one with these worries and the only one who wasn’t putting my health — physical and mental — first. That experience launched a self-care journey that altered my clinical outlook and practice.

A few weeks after I was discharged, I started trauma therapy to stave off posttraumatic stress disorder. I disclosed this to my patients, hoping their takeaways would be that a person in therapy isn’t broken or incapable of thriving — and being proactive can sometimes prevent problems.

Now, I have firm work-life boundaries. My patients don’t always like them, but they recognize the value in having a therapist who takes care of herself. I model this behavior because it’s what’s best for my patients — whether it’s them doing it for themselves or me doing it to be at my best for them. They understand the need for “me” time, and several have commented on their increased distress tolerance when they can’t get an appointment [at] the exact time they want or [when] I don’t immediately respond to an email.

In my practice, all clinicians — myself included — are required to take a minimum number of days off annually, which don’t carry over. I want therapists [on my staff] who take breaks and prioritize what matters to them, and, honestly, it leads to greater work enjoyment.

Because COVID-19 has increased access to care via telehealth, I’ve found boundaries to be more critical than ever. If we want to provide our patients with the best resources, then we as their therapists need to be at our best — and that’s not possible without time away from our work.

— Stephanie Woodrow is an LCPC and owner and clinical director of the National Anxiety and OCD Treatment Center in the Washington, D.C., area. She was an inaugural recipient of the Emerging Leader Award from the Anxiety and Depression Association of America and is an active member of that organization as well as the International OCD Foundation.

 

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Keeping up with telehealth regulations

The laws and regulations that govern counselors’ use of telebehavioral health are, for the most part, decided at the state level — and that can make it difficult to keep track of changes during extenuating circumstances such as the COVID-19 pandemic, says Lynn Linde, the chief knowledge and learning officer at the American Counseling Association.

However, the exemptions that many states enacted to loosen regulations at the start of the pandemic to expand the use of telehealth have mostly expired, Linde says. This is the case not only for professional counseling but also for many other health-related professions. 

Today, telebehavioral health may no longer be an option for some professional counselors — especially if a client is not physically located in the same state as their practitioner. Rules vary widely, and what is allowed for telehealth in one state may not be allowed in a neighboring state, Linde notes.

Telebehavioral health regulation “is still all over the place, but it’s much more limited than it was. Most states have gone back to their ‘old’ regulations” that were in place before the pandemic, says Linde, who is also a past president of ACA. “It’s not what counselors want to hear, but it’s the reality of where we are.”

Now more than ever, it’s incumbent on individual counselors to stay up to date on telehealth regulations in their respective states. One silver lining to the pandemic is that many state licensing boards are putting more information, details and updates on their websites — much more so than before the pandemic, Linde says.

“Telehealth is a wonderful way of working with clients, but we encourage [counselors] to ensure that they have the skills and are qualified to do it, are observing appropriate security and confidentiality measures such as using encrypted programs, etc., and [are] ensuring that they can legally do it by continually checking with the licensing board where their client lives,” Linde emphasizes.

One measure aimed at alleviating some of the disparity between states regarding telebehavioral health is the interstate Counseling Compact project that continues to gain momentum. The compact, an initiative that would allow counseling practice across state lines in those states that have adopted the compact, is finalized and will take effect once 10 states pass legislation to adopt it. Language in the agreement ensures that any state that adopts the compact will allow counselors to use telebehavioral health permanently.

Two states, Georgia and Maryland, passed legislation in 2021 to adopt the compact. This year, more than 20 states are in the process of introducing or furthering legislation to adopt the compact. Leaders involved in the project, including Linde, expect that the compact will reach the 10-state threshold before June 30, when many state legislatures end for the season. Ohio and Florida are making good process on such measures, and bills have been sponsored in more than 15 other states, Linde says. 

[Update: Alabama became the third state to sign the Compact into law in early March.]

Launched in 2019, the compact project is a partnership between ACA and the Council of State Governments’ National Center for Interstate Compacts. Once a 10th state adopts the compact, the compact will become live, and those 10 states will form its governing body. Counselor practitioners should be able to begin submitting applications roughly six to nine months after compact commissioners are named and a commission is established, Linde notes.

Compacts are “the way of the future” to best treat clients, she says, and many other health professions — from social work to dentistry — are working on similar compact projects to make licensure and regulation more uniform and responsive.

• Stay updated on the progress of the Counseling Compact by visiting counselingcompact.org.
• Find out more about the ethical standards for telebehavioral health and other important information at counseling.org/COVID19.
• See Section H, “Distance Counseling, Technology, and Social Media,” of the 2014 ACA Code of Ethics at counseling.org/ethics.

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Learn more

• Search for articles with the tag “coronavirus” at ct.counseling.org.
• Find pandemic-related resources for counselors at counseling.org/COVID19.
• Read the ACA-published books Counseling Practice During Phases of a Pandemic Virus and Distance Counseling and Supervision: A Guide for Mental Health Clinicians, available at counseling.org/store.
• Connect with fellow counselors at community.counseling.org.

 

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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.