InSession: Pivoting in the New Era - April 2021

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Strategically Focused on Meeting FMHCA’s 2021 Goals During the COVID-19 Pandemic

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Meeting Needs of Behavioral Health Care and Human Services Organizations During COVID-19 Pandemic

11 Virtual Sandtray for Teletherapy 14 That One Clock App? It Is About Time.

16 Pandemic times : Attuning to sensitive clients with diverse healthcare beliefs.

18 Counseling Tips: Counseling During a Pandemic 23 Parenting a child with ASD as a Mental Health Professional (During The Pandemic) 29 How Mental Health Professionals Can Practice Self-Care, Overcome Grief, & Be Grateful During The Pandemic 34 Am I Suffering Trauma?

37 FMHCA 2021 Webinar Series Lineup 39 Pivoting the Couch: Creating Therapeutic Spaces During a Global Crisis 43 Couples In Crises During Covid 47 Pandemics , Coconuts, and the Quiet Crisis 50 Imposter Syndrome: Questioning Yourself During COVID 53 Behavioral Health: The Stigma of Reaching Out 55 Self-Care Strategies for Counselors During COVID-19 57 Legislative Update 59 FMHCA Bylaws FMHCA is a chapter of the American Mental Health Counselors Association and is the only organization working exclusively for LMHC's in Florida 3 INSESSION APRIL 2021

STRATEGICALLY FOCUSED on Meeting FMHCA’s 2021 Goals During the COVID-19 Pandemic Based on our theoretical orientation Clinical Mental Health Counselors constantly conduct evaluations, collect data, develop treatment plans, collaboratively establish long-term and short-term goals for our clients, align-based evidence interventions with our established goals, and monitor the progress of our clients towards attaining the goals. New goals may be developed as our clients master their goals or if appropriate the counseling relationship is terminated. Similarly, annual goals and objectives were developed to achieve the vision and mission of the Florida Mental Health Counseling Association (FMHCA) by the FMHCAs President based on previous goals, policies, procedures, a SWOT Analysis, and survey results received from FMHCA’s members. As we enter another phase in our physical year, I am excited to take this time to celebrate our accomplishments and share with you where we are with accomplishing our annual goals and how we are realizing our goals.

Let the celebration began! Thank you FMHCAs members, Executive Office staff, and Board of Directors. Collectively we have made significant progress towards meeting our annual goals. This year our goals align with the following categories: Association Growth Education/Training Inter and Intra-Group/Relations Board Efficiency Legislative Activity and Government Relations Strategic Planning Our association is growing, and we are expanding the benefits of being a member of FMHCA. I am excited to announce that

FMHCA added 300 new members to our organization between January 2021 and February 2021. Please join me in welcoming our new members. Our Regional Directors are contacting Counselor Education Programs to recruit students and RMHIs to become members. FMHCA’s Executive Office launched a membership campaign to recruit, retain, and reclaim members. Remember to renew your membership! Recruit at least one new member and receive a $15.00 credit to apply towards a webinar, conference, event, or your membership fee.

View FMHCA’s website to learn about and take advantage of the numerous Membership Perks and benefits of being a member of FMHCA. In collaboration with West Virginia Licensed Professional Counselors Association, FMHCA Members can register to attend the WVLPCA 2021 Virtual Spring Conference at a discounted rate.

FMHCA’s members can utilize the Member Directory and Qualified Supervisor Directory on FMHCA’s website to search for and connect with fellow colleagues with diverse expertise. Student members and RMHCIs can use this feature to locate Qualified Supervisors based on the practitioner’s license. We developed an RMHI Licensure Exam Scholarship to assist RMHCIs who are taking their licensure exam. Please consider donating to the scholarship fund via FMHCA’s website. You can now follow us on Facebook, Linked-In, Twitter, Instagram, and YouTube.

We encourage you to join FMHCA’s Facebook Group to network with informed professionals, gain resources and receive support.

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Although COVID-19 altered the way we provide professional development. FMHCA expanded the opportunities to receive continuing education. Members can enhance their knowledge in cultural diversity, trauma, evidence-based practices, treatment & assessment, counseling children, adolescents & family, as well as the business aspect of providing Mental Health Counseling from the comfort of their office, home, or while commuting. With the onset of the COVID-19 Pandemic, the Education Committee and Executive Office swiftly transitioned the Annual Conference to a Virtual Summit.

During the month of February 714 individuals throughout Florida and 1958 registrants, across the US, Canada, and Ireland attended a 20-day Virtual Summit. Over 1000 brochures were shared and read by viewers.

Attendees were able to receive up to 150 CEUs, obtain new certifications, engage in interactive professional development sessions, and network with colleagues while earning their required CEU to renew their license. To continue to meet the diverse needs of FMHCAs members, On-Demand Webinars are available throughout the year allowing members to receive over 60 CEU’s.

Regional Directors, Board members, and the Executive Office staff work closely with regional chapters to support and provide at least two events per year as permissible during the Pandemic.

FMHCA state chapter is intentional in its efforts to strengthen inter-group and intragroup relations with regional chapters, state chapters, and the Florida Board of Clinical Social Work, Marriage & Family Therapy & Clinical Mental Health Counseling, and other Mental Health organization. FMHCA Board members regularly attend 491 Board meetings and encourage all members to also attend the meetings to enhance their knowledge about adhering to competent and safe practices in Florida. FMHCA showed support for the South Carolina Clinical Mental Health Counselors Association by announcing its Virtual Conference that was held March 5th and 6th and West Virginia Licensed Professional Counselors Association’s Virtual Spring Conference scheduled to occur April 8th and 9th. Through FMHCA’s “Three in One Campaign” members are encouraged to learn about and receive the benefits of joining all three levels of AMHCA at the local, state, and national levels. Furthermore, other professional associations such as AAMFT, NASW, and the Florida State Board have shown support of FMHCA’s legislative Bill.

FMHCA’s Board of Directors works diligently to serve its members and meet the professional needs of Florida’s Licensed Mental Health Counselors. FMHCA’s Board of Directs meets monthly, collaborate with fellow Board members through the Board of Director’s Forum in between meetings to conduct the business of the Association.

FMHCA has four Regional Directors who are tasked with conducting the affairs of the organization at the regional level in compliance with the Bylaws of the Association. The Regional Directors serve as FMHCA’s voice on the regional level concerning all the association’s activities for its membership including Chapter Relations and Chapter Formation, Membership, Education Programs, Conferences, Legislation, and Ethics. The Regional Directors serve on specific FMHCA committees and encourage members in their region to fully 5 INSESSION APRIL 2021

engage in the previously mentioned activities so that the entire state has its voice in the policies, procedures, and activities of FMHCA. Take the time to respond to the Regional Directors’ and Executive Office’s call to action and join a committee. We need your help in advancing the profession of clinical mental health counseling.

FMHCA is strategically focused on promoting legislation that recognizes and advances the profession of mental health counseling. On January 26, 2021, I was thrilled to receive the exciting news that SB 818 and HB941 was filed. The Senate bill by Senator Danny Burgess was conceptualized by FMHCA. FMHCA’s Government Relations Committee (GRC) worked collaboratively with our lobbyist, Corinne Mixon of Rutledge & Ecenia to draft a COVID-19 mental health Bill. The Bill sponsors were secured by FMHCAs lobbying team. The House bill was released

by State Representative Sam Garrison. The GRC is reaching out to other professional associations and the State Board to support the Bill. However, we need your help with moving the Bill forward by signing up to become a member of the FMHCA’s 2021 “Legislative Days” delegation, attend a briefing, or listening to a recorded briefing, and then meet with legislators online to promote the Bill. The GRC will prepare you to meet with legislators by providing you with “talking points” and giving you a few tips for meeting with your legislators.

SB 818: Mental Health Professionals; For purposes of clinical experience requirements for licensure as a mental health counselor, deleting a requirement that a licensed mental health professional be on the premises when a registered intern is providing clinical services in a private practice setting authorizing courts to appoint mental health professionals licensed under ch. 491, F.S., as experts in criminal cases, etc.

A special thank you to the members who completed the members’ survey in December that helped to conduct a SWOT Analysis, receiving feedback from FMHCA’s general membership, and set the foundation for developing a 5-Year Strategic Plan. As you can see FMHCA is achieving the Presidency Goals and objectives set for 2021. However, we need you to continue to remain actively engaged in all aspects of our association’s activities. Continue to help us grow our membership by sharing the benefits of being a member of FMHCA. Sign up to join a committee. Join our Legislation Day delegation, participate in events held in your region, increase the awareness of mental illness, and reduce the stigma associated with mental illnesses, continue to attend webinars, network with your colleagues on social media, register for FMHCA’s 2022 Conference, submit an article for our “InSession Magazine” and stay safe by following CDC guidelines.

Thank you for your dedication, support, and being a member of FMHCA,

Deirdra Sanders-Burnett Deirdra Sanders-Burnett, Ph.D., LMHC FMHCA-President 2021

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MEETING NEEDS OF BEHAVIORAL HEALTH CARE AND HUMAN SERVICES ORGANIZATIONS DURING COVID-19 PANDEMIC

Compared to other health care settings, BHC organizations were more likely to report staffing issues (55%), specifically related to retention and working from home. BHC organizations also were more likely to report issues with implementing telehealth and virtual services, as well as with travel restrictions and the reallocation of staff to different locations.

The past year has been challenging for health care professionals across all settings, include BHC organizations identified specific needs those in behavioral health care and human related to: services (BHC). We recognize the incredible challenge that you are facing to provide Upgrading technology/equipment for telequality care, treatment and services to behavioral health activities individuals served – particularly as concerns Implementing virtual patient/client intake about mental health and substance use grow Suspending communal dining activities as the COVID-19 pandemic lingers on.

A BHC Quality Experience Director who To better learn about the needs of health participated in the study reported, “Few staff care and human services organizations in the had ever worked from home, so managers current and evolving pandemic, The Joint needed to spend more time with staff in the Commission, Joint Commission Resources, beginning to not only help acclimate, but to Inc. and the Joint Commission Center for also offer support because shelter-in-place Transforming Healthcare conducted an had such a huge emotional/mental impact.” online questionnaire in September 2020.

Your Health Care Worker Wellbeing The questionnaire, administered by C+R Research, had a total of 735 respondents The continued onslaught of COVID-19 has representing a variety of health care settings, pushed health care and human services including BHC, hospital, home care and organizations to their limits and workers ambulatory. It identified needs for beyond physical exhaustion. The majority of enhancements, changes and improvements BHC organizations (91%) agreed that tools to to patient safety and quality of care amid help manage employee morale are important COVID-19. resources during COVID-19.

Key Findings from Behavioral Health Care and Human Services Organizations A total of 119 BHC organizations participated in the questionnaire, including those that provide: Substance use disorder treatment Community-based mental health Family and/or children’s services Methadone/opioid treatment Services for individuals with intellectual disabilities Eating disorders

“Mental health is an important part of our function as an agency. The agency has always offered free counseling to staff who need it and has been encouraging since the beginning of this pandemic to use the services, if needed,” explained one BHC study participant.

“For example, my Executive Supervisor checks with us to see how we are doing emotionally before talking about work. Sometimes we simply meet as a staff to share how we are feeling and our anxieties. Emails are constantly sent by the CEO with suggestions on how to take care of ourselves and what to do.”

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COVID-19 Resources and Support

To help address concerns regarding health care worker wellbeing during COVID-19, The Joint Commission recently issued a special edition of its Sentinel Event Alert on managing safety concerns of health care workers during COVID-19. The alert encourages health care organizations to: 1. Foster open and transparent communication to build trust, reduce fears, build morale and sustain an effective workforce.

2. Remove barriers to health care workers seeking mental health services and develop systems that support institutional, as well as individual, resilience.

3. Protect workers’ safety using the National Institute of Occupational Health and Safety (NIOSH) Hierarchy of Controls framework.

4. Develop a flexible workforce; evaluate the work being performed and determine if it can be performed remotely.

5. Provide clinicians and others with opportunities to collaborate, lead and innovate.

One of the findings from the study that I found reassuring was that many BHC organizations credited Joint Commission accreditation for helping them apply safety culture principles and concepts during the pandemic. In addition, many organizations said that our requirement to have an emergency management plan in place helped them quickly respond at the start of COVID-19.

In the coming months, we plan to use the findings from the study to further support our BHC organizations. The findings will guide the resources and tools that we develop and share with our accredited organizations – helping them overcome challenges and identify solutions to continue to provide safe and quality of care for individuals served.

For the latest COVID-19 resources, please visit The Joint Commission’s Coronavirus Resources portal at www.jointcommission.org/covid-19/.

The public portal contains links to recommendations for health care worker health and wellbeing, webinar recordings for different organization types, and information on our advocacy efforts for health care and human services workers during the pandemic.

The Joint Commission is here to support you The alert, applicable to those in human during COVID-19 and beyond. We can bring services, is the first in a series that will help the BHC community together to share best address health care workers’ concerns and practices and solutions as we continue to fight provide guidance on how to respond to them against this deadly pandemic. Thank you for all during COVID-19. that you do.

Written By: Julia Finken, BSN, MBA, CPHQ, CLSSMBB Julia Finken, BSN, MBA, CPHQ, CLSSMBB, is Executive Director of Behavioral Health Care and Human Services at The Joint Commission in Oakbrook Terrace, Ill. Previously, Ms. Finken served as a Joint Commission surveyor for 9 years and an associate director of business development for 3 years. Ms. Finken has worked in administrative roles in the health care industry for over 25 years. Her career has been dedicated to developing and implementing health care programs that balance efficiency, quality and financial outcomes.

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VIRTUAL SANDTRAY FOR TELETHERAPY

Virtual Sandtray is not an oxymoron. Granted the customary approach is for the client or family group to work on the Sandtray in the Counselor’s office. Yes, that is the easier way but what has been easy in Covid-19? Rather than give up this effective, engaging technique, therapists worldwide quickly made adaptations.

The Sandtray Technique class I teach once a year for University of Iceland has been online with professor and students in the classroom, while I beam in via Blackboard. This year their class was online due to Covid-19. As my Mama said, “for anything worth doing you can find a way.” So I invited the class into my Zoom for the initial demonstration and discussion. Then I sent triads into Zoom Breakout Rooms with one student as counselor, one as client and the third as observer. Their Professor and I dropped in to observe each breakout room. How hard was that to teach? Actually, it was easier than expected. I noticed that each student group was more concentrated on the sand tray and the client then with prior classes together in a classroom. The privacy of the Zoom room with client and counselor led to greater focus.

In some ways the Zoom Breakout Room was more like being in a therapy office without the distractions and noise of several student groups in the same campus classroom.

There are variations on how to work with distance Sandtray. Using the Sandtray in the Counselor’s office visible on screen, the client can direct the counselor on what items to place in the tray and where to place them.

The downside is that this misses the tactile elements of working in the sand and being directly involved in creating the tray scene. It may also limit the client’s options to choose figures and objects for the tray. Another option is for the client to have a tray using a bowl or plastic box of sand and whatever miniatures, small toys or small objects are available to use in the tray. In that scenario, the counselor observes the same way as in face-to-face Sandtray therapy.

Dedicated Sandtray Therapists did not allow a pandemic and distance restrictions to interfere with their favorite modality. You guessed it – Sandtray went Digital! Dr Karen Fried created an interactive digital Sandtray that client and counselor can view. She graciously offers a free version at https://onlinesandtray.com. There are more sophisticated, three dimensional online sandtray options for purchase or subscription. The Virtual Sandtray App ($169) and Time to heal ($79) are in the App stores for PC or Mac. Simple Sand Play for PC or Mac is a monthly subscription. The Virtual Sandtray App has added encryptions to 11 INSESSION APRIL 2021

support client confidentiality, a feature that is important for telehealth sessions. Ask for a Virtual Tour or limited option to experiment before buying.

Counselors working with children may find that children are eager to put their hands in real sand and use their own toys or miniatures to tell the story in the tray.

Students immediately rallied to this idea of an creating online sandtray. One student suggested that the virtual reality site, Second Life, could become a type of Sandtray.

Considering privacy issues and the interactivity that is part of Second Life, that option seems too open and rift with potential confidentiality problems.

At key points in the Sandtray work or at the end of the session, seek the client’s permission to take a screen shot of the tray. These images can be reference points for comparing significant issues, identifying point of progress or noting differences each of which are valuable in session notes. Even for in-office sessions, photo visuals are useful for session records. Another benefit is “before and after” images can affirm how the client has progressed.

Thus far I have used the “lower tech” option similar to how the students practice in zoom breakout rooms with the sandtray on my side Covid19 has interrupted and forced us to and the client directing. Not many people have reimagine counseling. We may look back and find a box of sand at home. that some shaking routines pushed us toward even better ways to help our clients.

Written By: Dr Kathie Erwin, LMHC, NCC, NCGC Dr Kathie Erwin, LMHC, NCC, NCGC is an Associate Professor at Divine Mercy University School of Counseling, Green Cross Academy Certified Master Traumatologist, AMHCA Diplomat in Geriatric Counseling and Fulbright Specialist to University of Iceland. Dr Erwin served as field trainer for teams in Trinidad, India, Romania and trauma educator for Ukraine Project in Kiev. She is Secretary/Board Member of FMHCA

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!

C

e r s P e r n o t f e l rs al

We are now accepting presentation proposals for our FMHCA 2022 In-Person Conference & Virtual Summit Presenter Proposals Due By: August 1st 2021 Benefits of Presenting: Presenters will receive a $50 discount on conference registration.

Promotion of your name and credentials on our website and in all electronic and print marketing materials, where appropriate.

Recognition of your expertise by FMHCA and by other industry professionals.

Networking opportunities

FMHCA's goal is to provide education, legislative oversight, and networking opportunities. Our Annual Conference provides an opportunity for advanced professional Training. Take advantage of this opportunity and present at the FMHCA 2022 Annual Conference!

Presenter Eligibility: To be considered, presenters must have professional qualifications in good standing with their professional regulatory board, if applicable, possess the technical expertise necessary to present on a subject effectively, and meet one or more of the following: Have received specialized graduate or postgraduate level training in subject of presentation; and/ or Have extensive experience including at least five years of practical application of research involving subject of presentation.

Click Here to Submit Please Submit Questions at office@FLmhca.org or Call: 561-228-6129 13 INSESSION APRIL 2021

THAT ONE CLOCK APP? IT IS ABOUT TIME.

Hello, my name is Edna and I am a Tik Tok Therapist. Like many who may read this, as a seasoned Licensed Mental Health Counselor and private practice owner, I had to rethink my entire business and counseling model last March. Over the course of a weekend, my office went from hosting 45 in-person sessions weekly to all sessions over teletherapy, something we were not prepared or trained to do. So we buckled down and got familiar with technology.

For most of quarantine, I powered through telesession after session and had the usual worklife struggle while managing my practice, supervision, parenting three children in virtual school and marriage in a fast-paced/full stop world. Zoom, zoom. My social events, concerts and other forms of downtime were cancelled, so I felt higher anxiety and the load of counseling people in pain provided no outlet for that energy. Early on, I wanted to find the humor, so I created a Facebook Group for my friends called “Quirky Quarantine Memes.” My girlfriends met occasionally on Fridays through Zoom and those laughs and tears are cherished in my mind. They joked about social media keeping them positive and distracted and I secretly and briefly wished I had chosen teaching so I could look forward to summers off.

My workload did not slow down like others’ had and at times, it was busier than before.

In July, the loneliness was setting in. Sure, I had my family at home, but with no coworkers to

process what life had evolved to as Counselors, no social outlet and no plans to look forward to, I was at a point where I was ready for something different. My daughters had been making Tik Tok dance videos all summer and I had even gotten in on one.

Then in late July, I downloaded the App. A social media app that helps users create 15 second to 1 minute videos and then shares them with complete strangers. My husband is a vigilant government employee and reminded me that Tik Tok may be taken away and maybe that made it all the more exciting.

Week 3 of Tik Tok, I was scrolling and noticed there were other mental health professionals with accounts solely dedicated to disseminating mental health information.

They did it in a relevant, sometimes funny, but educational way. They were on Tik Tok for all of Quarantine and some even longer and had upwards of 100,000 followers. Up to that point, I had made silly voiceover and dance videos and reorganized my panty with small views and even less likes. Since my daughter, my youngest cousin and a few Girl Scouts followed, I kept the content PG. At the end of July, while I was waiting for my teletherapy client to sign in, I thought I could make a quick video for educational purposes celebrating my client reaching a goal using the Dora the Explorer song “We Did It.” It quickly had 300 views and I focused my content, followed other Tik Tok Therapists and honed in. I was hooked.

Since early August, I have made over 500 videos addressing depression, anxiety, the counseling process itself, the role of a counselor, the feelings experienced in counseling, topics to bring up to your child, teenager and spouse and marriage tips as I am trained to Level II of the Gottman Approach. According to analytics, my videos have been viewed over 2 million times. My most viral (just me) video is where I outline who cannot be your therapist. The first time posting had 107,000 views, was shared 41 times, received 15,000 likes and has 14 INSESSION APRIL 2021

generated 312 comments inquiring to know more or to express disagreement. To professionals, this is common sense, basic ethics information, but to viewers it creates an emotional reaction.

We Tik Tok Therapists have been able to educate others on Suicide Awareness and Prevention in September, as well as Domestic Violence, ADHD, Autism and others in October.

Tik Tok Therapists support, inspire and bring positivity to an uncertain world and counterbalance the idea that people are alone in all of ‘this.” The TT Therapists are from the US, Canada, Europe and beyond. They are as diverse and the populations we serve. We reach young people and middle-aged people. We encourage those in pain to reach out for support, to talk to someone and that mental health professionals are humans with complex lives and their own hurts. To me, it provides a release of creative energy, a professional support system, motivation and a goal. I am a Creator of necessary, relevant mental health content that is desperately needed at this time in society where people are unsure what is real,

true or honest and in a world that is bracing for a second pandemic of mental illness and traumatized medical professionals. A world that up until now has stigmatized mental illness and was not really sure what mental health means anyway. Tik Tok Therapists are normalizing, providing re-assurance and encouragement that mental health matters. #TherapyTikTok---It is not just a social platform, but dare I say movement. So, let’s move (and dance) and spread the awareness of mental health.

Edna is based in Northeast Florida and specializes in ADHD, anxiety, grief and life transitions for ages 2 to 72. As a Counselor Educator, she enjoys hosting Masters students in practicum and has been a qualified Written By: Edna supervisor for FL Registered Schaefer, LMHC Mental Health Counselor Interns since 2008.

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PANDEMIC TIMES: ATTUNING TO SENSITIVE CLIENTS WITH DIVERSE HEALTHCARE BELIEFS In a clip that previews her interview of Prince Harry and Megan Markle, Oprah asks Megan, “Did you silence yourself or were you silenced?” Her question reverberates in my heart like a Gregorian Chant. “Feeling silenced” is not restricted to royal offspring. It is a very isolating experience, a sign of social rigidity, and often a precursor to depression.

“Feeling silenced” is something I see often in my therapy practice, especially since the pandemic.

My therapy practice is primarily devoted to helping to relieve distress in people who have a highly sensitive personality (HSPs).

According to extensive research since 1996

by Dr. Elaine Aron and her international colleagues, high sensitivity is an evolutionary trait within 15 - 20% of animal and human populations, across all cultures. Although not a researcher, psychiatrist and bestselling author Judith Orloff, M.D. has also made a contribution, in this case, to the energetic healing of sensitives who suffer from excessive empathy and feel deeply the pain of the world.

You most likely have HSP clients in your practice. Sensitives are a minority in society but compromise 80% or the majority of clients in therapy. Sensitivity is not introversion, not pathology, not neurosis, although certainly a sensitive can be anxious, sad or depressed, and they can have had adverse events in childhood. HSPs are some of the most resilient clients you will see in therapy. A core wound in many HSPs is psychic isolation – the experience of being different, feeling misunderstood and not fitting in to the culture at large. This innate sensitivity can be compounded by inequities of gender, race, ethnicity, and sexual orientation. HSPs in therapy during the pandemic may need help to speak up about what they have felt silenced about, currently and in the past.This includes their experiences and views about healthcare.

HSPs are hyper-vigilant: their bodies absorb the feelings of others like sponges, which can make them ill. They tend to prefer alternative, complementary or integrative medicine over allopathic medical interventions. They have lots of questions and are likely to feel silenced by the prevailing health authorities. It is important for therapists to validate the HSPs process of free inquiry, to help such clients be with their indecision, to name their fears, and to trust their own inner wisdom. HSPs do not need to hear from their therapists variations of the same advice that they have heard most of their lives, e.g. “toughen up,” “grow a thick skin” or worse, “stop being so sensitive.”

Persons with a highly sensitive personality cannot just turn it off. Their nervous systems are wired differently.

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Your HSP client does not need to be fixed. If your HSP client seems to be espousing what you consider conspiracy theories, stay open in the present moment. Find a point of common ground. Consider the importance of the therapeutic alliance and whether you feel it would be useful to disclose your process and how you arrived at your perspective. Can you give your client a new experience surrounding differences? How might it feel if you agree to disagree on a matter important to him or her?

Remember, validating is not agreement.

However, validating is both verbal and nonverbal. Even over telehealth platforms, clients will tend to trust body language over what is spoken. HSP clients are on the alert to your non-verbal communications. There's a lot you can do to alleviate the pain of an HSP. Most notably, you can: 1) support your HSP client in developing self-trust, and 2) alleviate the HSPs loneliness of being different, by listening deeply.

In a free society, the intersection of individual liberty and public health is a worthy place of Socratic exploration and personal growth.

Written By: Robin Leigh, LCSW, MSW, MFA Robin Leigh, LCSW, MSW, MFA, is a private practice therapist with special training in working with persons with highly sensitive personality trait. Her practice includes creatives, intuitives, HSPs, and empaths as well as grievers, caregivers, persons with chronic illness, and others experiencing life transitions. She enjoys sharing the healing possibilities of mindful writing with her clients. https://leighcounseling.weebly.com/

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COUNSELING TIPS: COUNSELING DURING A PANDEMIC

In October 2020, Vanessa Lane, LMHC of Massachusetts posted a short and simple message on AMHCA’s Open Forum expressing that her “practice is full to the eye-teeth” and asking her peers, “Is it really busy where you are, too?”

I had been wondering the same thing. At the time, I was working five-to-six days a week, sometimes seeing more than 40 clients in a week, and I was still booked out about six weeks despite having stopped accepting any new referrals. The other counselors in my group practice were having similar experiences, and I was hearing similar experiences from other clinical mental health counselors (CMHCs) across the country.

As more and more AMHCA members started responding to Vanessa’s question, we decided to create and launch a survey in the forum. To my surprise, 654 AMHCA members responded!

Here are some of the key findings: 58 % of members said they had more referrals than usual (27 % said they had the same amount of business as usual, and 15 % said they had less as compared to usual).

36 % of members said they were expanding their hours of availability to try and meet the increased demand for therapy.

27 % were limiting new referrals, 26 % were referring to other CMHCs more than usual, 11 % stopped accepting any new referrals, and 8 % hired additional staff to try and address referral increases.

63 % of CMHCs agreed with the statement, “I have reason to believe that clients in my geographical area are finding it hard to find a counselor/therapist.”

39 % of CMHCs agreed with the statement, “Because of an increase in workload, I am finding it difficult to see my clients as frequently as I/they would like.”

35 % of CMHCs provided telehealth services prior to the pandemic as compared to 95 % during the pandemic, representing a 3-fold increase in telehealth services.

40 % of CMHCs were providing telehealth only, suspending any in-person sessions.

The average counselor estimated that 68 % of sessions were conducted via telehealth vs. inperson.

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In addition to highlighting how the pandemic caused a shift towards telehealth, the survey illustrated that during a time of unprecedented stress and we CMHCs were working harder than we ever had.

In 2020, the COVID-19 pandemic ushered in a mental health crisis the likes of which most of us have not seen in a lifetime, including substantial rises in substance use and drug overdoses, clinical depression and anxiety, domestic violence, and suicide. A January 2021 survey conducted by OnePoll found that 1 out of every 6 Americans sought therapy for the first time in 2021, joining the 1 out of every 3 Americans who saw a therapist at some point during the year.

Over the course of this pandemic, I’ve tried to infuse research and clinical experience to generate a list of seven tips and strategies, some of which I’m hoping you might find helpful.

Tip #1: Not All Precautions are Reasonable Many clients with Obsessive-Compulsive Disorder (OCD) and various anxiety disorders struggle to determine whether the precautions they are taking to avoid COVID-19 infection are healthy or pathological. There’s a big difference between a client who wears a face mask when going to the grocery store and a client who never leaves his home and spends three hours applying a complicated and repetitive purification ritual using multiple chemicals and various UV-C light configurations before opening his package from Amazon.

On one hand, we CMHCs are tasked with treating OCD, often through exposure and response prevention protocols. On the other hand, we aren’t physicians or biomedical scientists, and we don’t want to give our clients terrible advice that opens them up to infection (while possibly opening us up to malpractice liability).

What can be done about this dilemma? My

approach has been to assist clients with creating a set of standards, often in writing, that uses the recommendations offered by the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and International OCD Foundation. If a client wants a little extra reassurance, I suggest reviewing the checklist with their primary care physician to ensure the precautions listed are reasonable but not overkill. This checklist serves as a rubric for separating reasonable precautions from OCD rituals.

Tip #2: Social Distancing Doesn’t Mean Social Isolation Social distancing is defined by the CDC as “keeping a safe space between yourself and other people who are not from your household.” This “safe space” is defined as “at least 6 feet.” Since most people with COVID-19 were infected when in close proximity to someone carrying the virus, social distancing is an essential precaution. On the other hand, social isolation has been connected to its own set of problems, such as damage to areas of the prefrontal cortex in children, higher mortality rates among seniors, physical inflammation, depression, heightened risk of heart disease and stroke, immune system impairment, and a wide range of elevated psychiatric symptoms among the elderly.

Go for a walk in the park or neighborhood, join an outdoor yoga or tai chi group, have conversations, or eat meals outdoors with others while maintaining greater than 6 feet of space on all sides; Use Skype, Zoom, FaceTime, or other technologies to talk with others through webcam; Play multiplayer games (especially ones where you can talk to and collaborate with others) on a console, computer, or mobile device; Purchase a virtual reality headset and use it to attend comedy clubs, board game nights, concerts, nature treks, group workouts, or other social events with friends, family, and 19 INSESSION APRIL 2021

others around the world

Examples of exercise that can be accessed with little or no equipment while social distancing On Easter morning, while my county was on include core training, aerobics, swimming, jump lockdown, I went for a walk in my neighborhood rope, yoga, calisthenics, resistance training, and park. I was delighted and touched to find that running/jogging/walking. Technology paves the children, teens, and adults woke up early and way for other options, some pricier than others. wrote dozens of inspirational messages in chalk I burn about 500 calories with just 30 minutes on the sidewalks. I never came within six feet of of boxing with my Oculus Quest 2 virtual reality anyone in the park that day, but I know I wasn’t headset, and it’s way more fun than boxing alone. without one. I’ve had a few clients purchase The Mirror or a Peloton, innovative equipment that allows you to participate in a variety of workout classes and regimens. Apple recently launched Apple Fitness +, Nintendo has the Wii Fit and RingFit, and the list goes on and on. Clients can also Google phrases like “home workouts” and watch video tutorials online.

Tip #4: Make Your Quarantine a Personal Renaissance Remember all those things you used to do or planned to do but never seem to get around to actually doing? Now’s your chance! I haven’t played baseball in years, but I got a baseball glove, a bucket of balls, and a pitching net and shook the dust off my arms. I read some of those books from my Kindle library that I never seem to get around to. Did you see those heart-warming videos of Italians signing in the balconies during quarantine?

Tip #3: No Gym Doesn’t Mean No Exercise We know that exercise enhances mood and strengthens the brain. Some of my clients stopped exercising during the pandemic, lamenting the loss of their access to the gym or to contact sports.Others started, diversified, or expanded their workout regimens during the pandemic, and you can guess which group seems to have maintained a more euthymic mood.

I ask my clients, “What would you do if you had plenty of time on your hands?” Many of my clients got back into painting, drawing, sculpting, coloring, writing or playing music, reading, signing, writing, learning foreign languages, gardening, knitting, and a host of other enjoyable pastimes. For those who struggle to come up with ideas, a Google search with keywords such as “stuff to do” or “list of hobbies” might help generate ideas.

Tip #5: Make Telehealth Fun and Rewarding “Zoom fatigue” hit me pretty quickly. Day 1 of telehealth sessions was pretty boring. My eyelids were getting heavy. I was getting bored, and I knew I’d need to spice things up. I bought a standing desk and started doing my sessions 20 INSESSION APRIL 2021

on my feet. I noticed my energy level rising. I also found that I really liked using screensharing to collaborate with my clients on genograms, cost-benefit analyses, decisional balances, thought records, art therapy, and session notes and treatments plans. I sometimes play short video clips for my clients that illustrate concepts we’re exploring. I played a mobile game for kids with a client to practice CBT skills. I got a digital photo frame and put it next to my computer so that photos of nature and quotes from the heroes who inspire me were constantly cycling by. I use an oil diffuser for aromatherapy filled with my favorite scents.

Tip #6: New Routine Trumps No Routine Towards the beginning of the pandemic, I noticed that while some of my clients were starting to decomp, others were improving. I studied them closely to see if I could find out what they were doing differently. I found that my clients who were doing the worst had not managed to replace their disrupted routines with new ones. They seemed aimless, and I thought they could use the power of routine. I devised an electronic tool called a “Daily Plan” that prompts clients to sit down each morning and come up with at least one commitment for the day in each of the following categories: Something productive (i.e., gives you a sense of accomplishment, contribution, or success); Something physical (i.e., a minimum of 2030 minutes of mild, moderate, or intense exercise); Something social (i.e., involves interaction with others while still social distancing); Something meaningful (i.e., gives you a sense of value or purpose); Something entertaining (i.e., is fun, interesting, and/or engaging); Something relaxing (i.e., helps you to destress, relax, or unwind).

My intention was to help clients develop wellrounded routines. I explained to them that at the end of a day in which they did at least one thing in each category, they would likely be able

to say to themselves, “This was a day welllived.” I found that clients who used this tool often reported an improved mood.

Tip #7: Counselor, Health Thyself!

This one’s the simplest tip on my list, but it’s not the easiest one. Take your own advice. Do what you’re trying to help your clients do. Ask yourself, “If my client were experiencing this, what would I think would be good for them?”

Then ask yourself, “Am I doing that myself? If not, why?” We must see clearly if we are to yield the torch for our clients as they find their way through these darker times.

Written By: Aaron Norton, LMHC Aaron Norton is a Licensed Mental Health Counselor and Licensed Marriage and Family Therapy serving as Executive Director of the National Board of Forensic Evaluators, Adjunct Instructor at the University of South Florida, Southern Regional Director for the American Mental Health Counselors Association, and PastPresident of the Florida Mental Health Counselors Association. He has nearly 20 years of clinical and forensic experience at Integrity Counseling, Inc., was awarded Mental Health Counselor of the Year by the American Mental Health Counselors Association and Counselor Educator of the Year by the Florida Mental Health Counselors Association in 2016, Researcher of the Year by Florida Mental Health Counselors Association in 2020, and has been published in several social science journals and professional magazines in clinical mental health counseling.

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PARENTING A CHILD WITH ASD AS A MENTAL HEALTH PROFESSIONAL (DURING A PANDEMIC) There is a saying in the ASD community: “When you’ve met one person with Autism, you’ve met ONE person with Autism” meaning Autism Spectrum Disorder is different than other DSM-5 disorders because it can look vastly different in different people. I understand what I have to share will not apply to every child or every family living with an ASD or special needs family member, nevertheless, I am hopeful you will get something useful from this article. Please also know my son with ASD helped me with this article, and I have his permission to share everything I have written.

In my son’s case, he has difficulties with executive functioning skills, difficulties with some fine motor skills, and difficulties with social skills. His frustration tolerance is also very low. While his intellect is on par with a college student, socially, he can come across quite a few years younger than his chronological age. He has trouble modulating his voice, i.e., speaks too loudly sometimes and also may say inappropriate things.

As is in the therapy room, I had to recognize “it’s not about me, it’s about him and it’s about what works for him” rather than my pride as someone who earns an income helping other families with similar issues. In light of that, in order to help him with some of his executive functioning skills, shortly before the pandemic, we hired an amazing

tutor / personal coach so he could have someone other than his parents working with him. When the pandemic hit, we lost that resource and my husband and I became more than just our son’s parents - we became his teachers, his life coaches, and much more along with being his parents all rolled into one. Additionally, he did not transition to online learning as efficiently as his neurotypical siblings or his classmates.

I must admit, even though I knew better, I fell prey to a common assumption about people with ASD, in that I thought that online learning would be “easier” for him. I thought it would be easier because he would not have to deal with the areas that challenged him, i.e., social skills. I thought online learning would perhaps be more efficient for him and less stressful. It turned out to be the opposite. For someone who has challenges picking up on facial expressions, tones of voice or “reading between the lines”, having everything online is quite challenging.

Especially when the person who experiences challenges in those areas assumes everything is” fine” and keeps moving on, not realizing he is missing important information or leaves an online meeting without truly understanding what is being asked of him.

Thinking he understands it, telling his parents “I’ve got it” only to find out the day before or the day something is due, he did not completely understand it and now there’s not 22 INSESSION APRIL 2021

enough time to adequately do the (assignment, paper, or task.) In-person learning obviously gives us so much more than online. One can get a “sense” from another person, which gives us pause or leads us to ask a question. We obviously lose that when we are doing life online. It is easy to slip by, and it is easy to go unnoticed as one is floundering, because if one was meeting in-person others would likely (but of course not always) pick up on the weak signals. For my son, it was easy to skate by, do the bare minimum, and suddenly, nearly a year is lost.

Parenting a child with special needs can be extra challenging. A neurotypical child grows, matures and parent transitions from siting alongside their child, helping with homework, to checking in as they do their homework, and ultimately the child will come to the parent when they are stuck or need help. Not in every case, but often, with special needs children, that parent must stay on top of that child daily never able to transition to the “let me know when you need help,” and it can be exhausting.

Shortly after the pandemic began, I ended up feeling frustrated by my son’s challenges with learning entirely online because of that mistaken assumption that it would be easier for him. He had previously been an “A” – “B” student and was on track for a full Bright

Futures Scholarship. (Bright Futures is a scholarship from the State of Florida which pays for, depending on academic achievement, tuition, and text books). His academic performance dropped precipitously with the changeover to online learning.

He had an IEP, appropriate accommodations and support staff for in-person learning at his high school, but when learning was suddenly shifted to online, those accommodations and supports were removed. For example, there was no extra time for on-line tests or on-line assignments. If a direction was unclear, he had limited ways of seeking clarification, and this resulted in many poor grades or zeros on assignments. He only had one friend at school, who was not in any of his classes, so he could not (and would not) reach out to classmates for help. We attempted to talk him through challenges however, being the parents, he acted frustrated with us.

Teachers and administrators were of course dealing with the pandemic themselves, which resulted in most of our requests for assistance going unanswered. We were all struggling. It was also disappointing to see traditional senior year events canceled. My son had chosen to attend a neurotypical school as opposed to a school which specialized with ASD in part because of the extra-curricular activities available in a traditional school.

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Another very challenging issue which quickly arose, and one certainly not limited to ASD children and teens, was our son’s need for his laptop computer for school, but the computer was also a source of distracting entertainment. Again, my usual problemsolving suggestions did not work in our situation. I had always advised others to “put the computer in the common areas of the house, not the bedroom” for greater monitoring. Our son had a surgical wound and claimed to feel uncomfortable sitting anywhere except his bed. My husband and I both worked in-person at our office throughout the entire pandemic. We do not have a home office, and with both of us leaving the house to work, we were not able to be home to monitor our son’s computer use. We could not turn off the internet because he and his siblings needed it for both online classes and for his homework assignments. We were in a frustrating conundrum.

advocate for himself.” The pandemic showed me how much work still needs to be done in that area with my own child. While we as parents tried to step back and allow our son to advocate for himself, it was honestly painful seeing him chose not to do the things that would help him. We did step in here and there, and we did our best to check in with him before we did.

I have always shared with other families of an ASD child, “For a child with Autistic Spectrum Disorder, it is vital to teach that child how to

While he had been using Discord (which is a way of communicating with others online for gaming) prior to the pandemic, he

While ASD children and adults are often thought of as introverts or “loners”, that is not a safe assumption. People on the spectrum can be just as social as their neurotypical peers. The few friends my son had outside of high school were all quarantining and none were available to get together even outside at a park. He became incredibly isolated and lonely. None of the resources I would typically have given to my clients on the spectrum were available during the pandemic. I.e., C.A.R.D.’s services were available but all online. No support groups were meeting in-person. No gaming groups (i.e., D & D, Dungeons and Dragons) were With the help of a coordinator with C.A.R.D., meeting in-person. Even practicing social (Center for Autism and Relates Disabilities which is a wonderful resource for ASD clients skills via shopping in public was not an option and their families) a plan was made: Our son due to the numbers of shoppers in stores learned how to use an on-line calendar. Then, being limited. We had also planned for him to get his first job so that he could begin to work he learned to schedule his class time and on employment skills, and that has not been schedule his time to work on his homework. available either. He felt just as isolated and If the homework does not get finished, once lonely as many of us have during this it is finished, the computer gets taken away pandemic. he loses his entertainment.

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significantly increased his time using it since the pandemic started. His father and I did not understand that he was making and developing new friendships that he desperately needed. Honestly, we did not handle it the best way. We did not understand how “friends” on Discord could be anywhere near as good as in-person friends and the reason for so much of his time spent on them. Note: I attended Dr. Daniel Kaufman’s workshop with the FMHCA conference in February of this year, “Treatment Guide For Video Game Disorder Issues: A Counseling Walk-Through” and he educated all of us in attendance that friends on Discord are just as important and just as real as in-person friends. Dr. Kaufman’s presentation helped me change my perspective and helped me be a better parent to my son in this area. I apologized to my son after participating in Dr. Kaufman’s workshop which he seemed to appreciate.

My son did salvage his Senior Year, he graduated high school in an outdoor graduation ceremony over the summer, and was awarded a partial Bright Futures Scholarship, for which we are thankful.

In sum, what are the take-aways? Resources that are still available, i.e., C.A.R.D., even if it is only online it is better than nothing at all. I also made time to seek out and talk with other parents who have children on the spectrum and listened to their challenges and they listened to mine. Connecting with other parents in a similar boat felt good. One parent I connected with shared resources I had not known of despite working in this area for many years. Focusing on empathizing with my son also helped reduced my feelings of frustration i.e., his father and I still refer to things from our Senior Years, but his was permanently changed and he will miss out on many of those Senior remembrances. It stinks. He may have ASD but he still knows he missed out and it just stinks. Additionally, we do the best we can and not beat ourselves up over our mistakes. We look for substitutes for

the supports that we had pre-pandemic. We engage in healthy self-care (i.e., oxygen mask on the parents/caregivers first so that they in turn can help their children.) We make time to listen, and perhaps push in a bit deeper to make sure he has the opportunity to fully express himself because it can be more challenging for him to express himself.

Increasing caregiver awareness, i.e. I am aware I can get caught up in my private practice or my own “stuff “that I can lose perspective, assume too much and do not always listen as well as I could. I am not my child’s counselor; however, I can carry those skills I have – empathy, active listening, patience and so on with my own child.

In case you are interested, he is taking college courses this semester and is doing well.

Resources: C.A.R.D. https://www.centerforautism.com/, Bright Feats is both a paper and online special needs directory of all kinds of services for a variety of differing needs: https://www.facebook.com/BrightFeatsDirect ory/ Autism Speaks www.autismspeaks.org and Dr. Daniel Kaufman “Dr. Gameology” https://aoecounseling.com/ Bright Futures Scholarship https://www.floridastudentfinancialaidsg.org/ SAPHome/SAPHome?url=home

Written By: Laura PeddieBravo, LMHC, NCC Laura Peddie-Bravo is a Licensed Mental Health Counselor since 2001 and a Nationally Certified Counselor since 1999. Laura has served multiple roles in The Mental Health Counselors of Central Florida, (MHCCF), which is a chapter of FMHCA. She is now FMHCA's President-Elect. Laura runs a private practice in Winter Park, FL 25 INSESSION APRIL 2021

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HOW MENTAL HEALTH PROFESSIONALS CAN PRACTICE SELF-CARE, OVERCOME GRIEF, & BE GRATEFUL DURING THE PANDEMIC

Therapists give great advice, but we don’t have all the answers, especially when it comes to self-reflection. There is no better time than now for therapists to speak to a therapist of their own.

Besides listening to the troubles of all our clients during sessions, therapists have families of our own who we are responsible for making tough decisions for. For example, I am a mom of two school age sons. Because of distance learning, one of my sons became bored and was really struggling. My husband and I had to make the tough decision to send him back to in-person learning as soon as his school re-opened. While we realize there was risk of exposure involved, we saw greater risk in him potentially becoming depressed by having zero social interaction.

Quarantine does NOT mean isolation. Social distancing is the goal. We NEED connection to others even if we cannot make physical contact.

Overcoming Grief

The landscape of mental health has changed dramatically during the pandemic. Even mental health practitioners are feeling the negative affects.

To be present mentally and physically for clients, psychotherapists need to not only tell clients to practice self-care, but therapists need to set time aside for their own self-care.

Counselors are not immune to burnout. We are just as human as our clients.

When I felt the COVID fatigue set in, I took a few days off to go on a fishing trip. I found that unplugging and being one with nature was relaxing and refreshing. I felt rejuvenated when I returned to my office and could offer my best self to my clients.

Psychotherapists are a primary source of hope.

Clients come to us and depend on us to give them hope that their problems can be resolved.

Yet, we therapists may have reached a point of feeling hopeless ourselves.

A popular model suggests that grief is experienced in five stages—shock and denial, bargaining, anger, depression, and acceptance. I believe guilt and accounting for an adjustment period should be included as well.

Exercise and expressing yourself in creative outlets are two examples of healthy coping mechanisms as you work through the stages of grief. Whether COVID-related or not, many of us have experienced the loss of a loved one within the last year.

I lost my dad in March 2020, so I had a year of firsts without him, such as the first Christmas.

That void was felt and will continue to be felt.

My professional training tells me that the first year is the most difficult because new traditions are being formed. Because it is unhealthy for grief to be all-consuming, I limit myself to brief sessions. I set a five minute timer and allow myself that moment to let it 27 INSESSION APRIL 2021

all out, cry, and take deep breaths and then I resume the work I need to focus on.

When experiencing grief and missing the companionship of the loved one you lost, it’s important to seek companionship elsewhere.

Just a couple of weeks after my dad’s passing, my family added a dog, Archer Fiasco McLovin’ Tomko, a shepherd/ malamute/ husky mix. He has brought us so much joy and has been critical in helping us overcome grief. When I look at Archer, I also remember my grandfather who was so kind to animals, and I realize I inherited that trait from him.

As a way to cope with my grandfather’s passing years ago, I used his denim jeans to sew a comfort animal. I found a pattern online to sew a teddy bear. This helped me heal.

Focus on Gratitude I suggest to clients all the time to create a gratitude ritual in their home. At the dinner table, each person has to say one thing they like about all the others. Or, ask three people in your life three things they liked about their day.

Focusing on gratitude releases both dopamine and serotonin, which are the same hormones that antidepressants work with. By writing gratitude lists and making note of the things that bring us joy, we can permanently restructure our brain, called neuroplasticity.

Our joy tends to be contagious, just as our negativity is. We can choose what energy we want to spread to others.

Pivoting My Business As every business owner has had to do, I have had to shift my business model due to the pandemic to stay afloat. As a therapist in South Florida, many clients are senior citizens and therefore in a high risk category to contract the virus. My staff at Clarity Health Solutions in Jupiter, Fla. made ourselves available to our clients via telehealth sessions.

Telehealth was first introduced to many people during the pandemic, but I am actually a pioneer in the field. I was ahead of the times when I founded a cutting-edge etherapy company, Elite E-Counseling, LLC, to provide HIPAA compliant video conferencing sessions for Florida residents way back in 2006.

Clarity Health Solutions has always offered group therapy in addition to in-person therapy. During the pandemic, we created a group specific to people suffering with the stress and anxiety associated with COVID-19.

Because I understand that therapy is costly, I have done my best to make it accessible to anyone who needs it. I host a weekly Facebook Live that is free of charge to watch and participate in. There is a different topic each week. I also appear in a recurring weekly segment on CBS12 in West Palm Beach to offer all the viewers insight on a relevant mental health topic in the headlines.

We always have and always will evolve as a business to cater to, meet, and exceed the needs of our clients at any given moment.

Shift In Mentality Mankind has been suffering from mental health issues for decades, even centuries.

Until recently, sufferers felt they needed to hide these feelings, sweep them under the rug, stay quiet, be ashamed, and pretend nothing was wrong. The pandemic has gotten people talking about mental health. If there is one good thing to come out of all this, it is that mental health is no longer a taboo topic.

More people recognize they need help and are getting the help they need. The stigma of seeing a therapist is gradually evaporating.

Getting help for a problem or a struggle should be something to be proud of, not ashamed of. An increasing number of people are conducting web searches to find therapists in their area and booking appointments.

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I have a lot of experience working with first responders from 9/11, as well as local firefighters and police officers. I drew a parallel between the trauma that people suffered as a result of 9/11 and the trauma the pandemic is causing. On the surface level, they may seem like totally different things.

One was a terrorist attack and the other is a global health crisis. The similarities lie in the fact that they are stirring the same emotions —feelings of helplessness, fear of the unknown, anger, grief, and sadness.

environmental concerns are improving, and we all are regaining an appreciation for our freedom.

The very gift of love for others has now become their deepest pain. This pandemic is not an indicator of failure, but a process of nature. It is an opportunity to learn to establish new protocols. We will be more prepared in future events, but like any learning experience, we need to fall before we can soar. People are connecting in new ways, families are getting reacquainted, stressed people are being forced to relax, our

I am hopeful that those who are struggling will continue to reach out to professionals to guide them through all these emotions. The mental health professionals are here to remind everyone of the light that may have dimmed. Seeing a professional doesn’t mean you are broken; it means you are brave.

Psychotherapists support their clients’ healing journeys, helping them to grow through the pain and not be trapped in it.

With more and more Americans getting vaccinated, we are now experiencing hope and some light at the end of the tunnel that previously looked like a dead end. Let’s be real though, we are not out of danger and this will continue to haunt our nation for years to come, but we have a better handle on mental health care.

Written By: Jennifer Tomko, LCSW Psychotherapist Jennifer Tomko, LCSW owns Clarity Health Solutions in Jupiter, Fla. She works with teens, adults, and senior citizens struggling with a wide variety of issues including stress, depression, trauma, grief, mood disorders, anxiety disorders, parenting, marriage, divorce, low motivation, sexuality, domestic violence, addiction, and dissociative identity disorder. She is trained in Eye Movement Desensitization and Reprocessing (EMDR) and TraumaFocused Cognitive Behavioral Therapy (TF-CBT).

The next 491 Board Meetings are scheduled for May 6, 2021 , August 19,2021 , November 4, 2021 For additional information including: times, locations, and discussion topicsPlease Click Here

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FMHCA'S FAVORITES: S E L F - C A R E

E D I T I O N

We asked our network of mental health professionals: "What are you doing right now for self-care?" Here were the top 6 answers.

Incorporating daily Taking more breaks for exercise such as: walking, naps, deep breathing, and running, dancing, yoga, therapy sessions for and stretching. oneself.

Stimulating the mind more by reading (or writing) books, articles, and blog posts.

Incorporating nutrient Staying connected (safely) Getting creative by rich and energizing foods with children, spouses, starting (or re-starting) a into daily eating regimens and quarantine buddies hobby to light up the to create better habits. to avoid isolation blues. inner artist.

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AM I SUFFERING Trauma?

Often when we think of trauma we think in the context of something "bad" that has happened to us and our struggle over time to work through it. But, what happens when we are daily experiencing trauma? Our lives have changed considerably since March of 2020.

While mask wearing, social distancing, and sanitization has become our "new normal" (physically), we cannot underestimate the impact these changes have had on our mental health as well.

We all experience trauma in different ways.

While some individuals will typically resolve trauma after an impacting "event", others may struggle significantly and begin to develop long-term effects of trauma that may may develop into PTSD. In Chapter 3 of Understanding the Impact of Trauma written by the Substance Abuse and Mental Health Services Administration (SAMHSA) it states, "How an event affects an individual depends on many factors, including characteristics of the individual, the type and characteristics of the event(s), developmental processes, the meaning of the trauma, and sociocultural factors" (SAMHSA, 2014). What particularly stands out in this definition right now is "the characteristics of the event". While some traumatic events occur and end, we currently are living in a traumatic situation that has not yet ended. We wake up to it everyday.

What does this mean for us and the way our body responds to stressful events? It means that we can experience increased levels of anxiety, depression, and a state of dissociation and unrest that simply lingers.

One of the most common statements I hear right now is, "I don't know what I am feeling and I don't know what is going on with me".

There seems to be such an elevated sense of uneasiness that is not quite able to completely resolve.

True, we have physically adjusted to our new environment, but our bodies are experiencing less stimulation due to decreased touch, hugs, connection, intimacy.

Lack of connection for long periods of time can affect even the strongest of us. It is no wonder why many people who have never experienced anxiety, panic attacks, nightmares, and severe depression are baffled by the intense impact these symptoms can have on our well-being. While our tolerance of masks and societal adjustments have become largely adaptable.

It is not as easy to calm the "powerful mind" and subsequently our physical, mental, spiritual, and social health suffers in more ways than we immediately recognize.

So, what can we do? #1-Make a Plan: Identify what you have lost and determine what you think you need/want or have been lacking during this time. Sometimes, we just need to honestly acknowledge where we are at so we can begin to deal with it honestly and process our emotional grief. #2-Re-Establish Connection: Self-care may have previously been that thing that was negotiable but no longer optional. Whether you are taking scheduled moments throughout the day to just do some deep breathing, positive selftalk, or taking time to do something for 32 INSESSION APRIL 2021

oneself, make it a consistent intentional act of self-care. If connection has been limited with loved ones, create an alternative way to connect (cards, scheduled video chats, etc.).

Often anxiety occurs when our body longs for the things it used to have. To some degree it needs a new "process of association".

Adapting these actions/processes can go a long way in establishing a "new emotional norm" like we have adjusted to new physical and societal norms. By doing this, we tell our minds and body "Hey, I am still here" just in a different way temporarily. #3-Talk it Out: Never underestimate the power of releasing emotions through simply talking. I can't count how many times I've rambled on with a friend and at the end of it all I took a deep breath and said "Man I didn't know I even needed that". Give yourself space and freedom to process your thoughts and feelings.

What cannot go unnoticed is while we are masking our faces, we should consider where we are also masking our feelings. I know for me, the hardest part has been the realization of facing this pandemic on multiple emotional levels I did not expect: through my eyes as a mother, a co-worker, a family member, a community volunteer, a leader, a counselor. Each layer carries it's own sense of grief within it that is undeniable. It's just difficult! So, I've had to give myself a lot of grace throughout this season of change for us as a society. I hope these simple steps also encourages you to take some time to evaluate where you stand, identify needs and wants, and allow yourself to openly process how this "new normal" affects you. Always remember, even in the midst of pain and discouragement, healing and growth is there too!

References: Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services.

Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191 Written By: Tanya McIntyre, MA, LMHC Tanya is a Licensed Mental Health Counselor and owner of As I Am Counseling & Therapy, LLC. Counseling specialities include anxiety, depression, addiction, and trauma. She is additionally trained in EMDR.

We Invite you to Join FMHCA's "FL Mental Health Counselors Networking" Facebook Group The facebook group is a space to network, share tips/tricks, and any helpful information or resources!

Join Now! 33 INSESSION APRIL 2021

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Presenter: Demenna Milord, LMHC. Friday, April 9th, 2021 2PM-4PM EST | 2 General CE Credits CE Broker Tracking #: 20-764531

Presenter: Amber Lange, PHD, LPC, CAADC, Konja Klepper, Ph.D, Megan Mahon, Ph.D, Carrie VanMeter Friday, April 16th, 2021 2PM-4PM EST | 2 General CE Credits CE Broker Tracking #: 20-806310

Presenter: Vassilia Binensztok, PhD, LMHC, NCC Friday, April 23rd, 2021 2PM-4PM EST | 2 General CE Credits CE Broker Tracking #: 20-764561

Presenter: Jennifer Dahl, MS, CRC, LMHC, LLC Friday, April 30th, 2021 2PM-4PM EST | 2 General CE Credits CE Broker Tracking #: 20-816576

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Presenter: Maureen Pollard, MSW, RSW Friday, May 7th, 2021 2PM-4PM EST | 2 General CE Credits CE Broker Tracking #: 20-764853

Presenters: Patsy Evans Phd, LMHC, CST, DOM, Wendi "Nicki" Line LMHC, LAPC, CST, CKAP; and Michael Holler LMHC, CKAP Friday, May 14th, 2021 2PM-4PM EST | 2 General CE Credits CE Broker Tracking #: 20-764905

Presenter: Nelson L. Hadler, LCSW, CAC, ICCS Friday, May 21st, 2021 2PM-4PM EST | 2 General CE Credits CE Broker Tracking #: 20-764911

Presenter: Wendi "Nicki" Line, LMHC, LAPC, CST, CKAP Friday, June 4th, 2021 2PM-4PM EST | 2 General CE Credits CE Broker Tracking #: 20-765059

Presenter: Laney Rosenzweig, MS, LMFT and Amy Shuman Friday, June 11th, 2021 2PM-4PM EST | 2 General CE Credits CE Broker Tracking #: 20-765069

That's not all! Full lineup of our 2021 Webinar Series can be viewed by clicking here.

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37 INSESSION APRIL 2021

PIVOTING THE COUCH: CREATING THERAPEUTIC SPACES DURING A GLOBAL CRISIS

Like many, when Covid-19 initially struck I packed up my school-based office and scrambled to figure out how to provide telehealth services for the first time. Despite the stress of fumbling through this I felt assured that within two weeks- a month maximum, we would all be back to our offices and our lives. Children would be back in school, parents and others back to work, life would go on. What would unfold would leave not only myself, but others awestruck in the saddest possible ways.

I watched as Covid-19 took root across the United States affecting those both young and old. I watched as beloved front-line workers, many of whom were therapists also contracted the virus. Despite this, I remained hopeful that we would be able to contain the virus and return to life as we knew it. My clients, teenagers, struggled with the transition to being home and maintaining schoolwork. Quickly, not only did I become a tele-therapist, but a resource case manager. I spent all available moments looking for community resources for my clients while assuring them although things were swirling around them, therapy could remain.

Within a few weeks, I was struck with the realization that tele-therapy was here to stay.

My cozy office with its spacious couch and ambient lighting was gone. It was time to create that space virtually for my clients.

What appeared to be a beautiful window backdrop complete with fairy light accents that just happened to be in my home, was in reality, a hastily thrown together backdrop created on a bare wall in a corner of my home devised with decorations for a baby shower that Covid-19 prevented me from throwing for my dear friends. That curtain served as a welcoming environment for my clients who had already lost all sense of normalcy. Their loss was coupled with my own. I helplessly listened to my client’s loss and sadness while attempting to address my own. The burdens of it all were heavy and my ability to help myself and my clients often felt minimal. While I had once been able to at least provide these teens a safe physical space for an hour, now they were often at home with many siblings and problematic dynamics that were on display in full force.

My heart was heavy but alas, therapy persisted.

The teens and I found routines in our sessions and ways to make tele-therapy nearly as welcoming as it had been. The world continued to swirl, but for those 50 minutes things seemed a bit more normal, sometimes even more so as we all adapted to having therapist and clients virtually in our most private spaces, our homes. We had all begun to cope as much as we could with the ever-changing world and CDC guidelines. The 38 INSESSION APRIL 2021

therapeutic space was working, and things felt manageable on the “virtual” couch until once again things changed.

Mandates came, school were to return to inperson learning. After 5 months of virtual therapy, it was time to re-enter my office and once again pivot. When I re-entered my office the third week of August in preparation for my clients return to school and therapy, the dusty daily calendar still read March. It felt like a lifetime has passed during those 5 months.

My teen-friendly office was a CDC-guideline nightmare. There was not six foot of space for social distancing, there was a communal fidget basket, snacks, markers and coloring pages for sharing. I looked around at my cozy space and pondered how I could make my space safe without it feeling sterile and cold. I rearranged the room and rearranged it again. A tape measure signaled my success at creating social distancing space and a sign indicating the need to wear a mask in session along with a bottle of hand sanitizer replaced my candy bowl. A basket of disinfectant replaced my fidget basket.

Once the physical space was created the magnitude of what I was about to undertake hit me with unrelenting force. I was bringing clients into my office who had the power to infect myself and others with Covid-19. Not only would I be sanitizing after every client, I would be providing therapy in a mask.

Everything I learned about minimal encouragers and being attuned to my client’s facial features was gone. How would my clients react to my changed office space and not even being able to see my face? On August 31, 2020 I would have the answers to these questions and some that never occurred to me. My clients were brought into the office over the course of that first week and guidelines were explained. I joined my clients in the feelings of uncertainty about what would come next. We blinked over our masks and I hoped the pensive smile under my mask would show through sincerely.

My clients adapted to this changed therapeutic space and braced themselves for more change. Soon, cases of Covid-19 were occurring within the school system and clients were being quarantined for 10-day increments. Now we all live between the virtual world and in person therapeutic services. Therapeutic spaces are precariously moved through back and forth as if to prevent us all from becoming too comfortable. Here in 2021, the world is continuing to swirl.

So, what advice would I have for therapists looking to create a therapeutic space and pivot their metaphorical couch?

1. Realize that for many it is your empathetic and steadfast nature that is the therapeutic space.

2. Self-care is important. Like empathy, burnout is palpable. Providing therapy through a screen or speaking through a mask for any and all social interaction is exhausting and isolating. While facials and bath bombs are great, what rituals and activities are you taking part in to fill and renew your heart and 39 INSESSION APRIL 2021

spirit? Take time to cultivate self-care activities and rituals to recharge.

3. Create a physical space you enjoy being in whether that is in your physical office or a make-shift virtual office at home. If you are providing therapy in your home create a dedicated office space or section within your home to allow yourself to create boundaries between your home and your work.

My experience with creating a therapeutic space during a global crisis highlighted that therapeutic spaces, like people, can and will adapt and remain. While our hearts may be heavy, they are still welcoming and beating hope for our clients.

Written By: Jessica Yanson, LMFT, LMHC, CRC

Jessica currently works for a school-based nonprofit as well as in her private practice, Cultivating Healing, LLC. Jessica works with teens and adults specializing in work with highachievers, anxiety, chronic illness, and those affected by Covid-19. Jessica has a passion for working with those from marginalized communities including the LGBTQIA+ and disability communities.

hat You N W e e ed k a T This season has taken a toll on us all.

Choose & hold onto your favorite quote/ saying submitted by your peers.

Stay connected.

Hope for the best plan for the worst.

Control the controllable

Visualization is the bridge between our inner and outer worlds.

Life is like a roller coaster, full of ups and downs, we just have to recognize this and take the ride.

This too shall pass.

Slow down, breathe deeply, and look for the moments that glimmer.

There’s opportunity in crisis

Our main task in life is to give birth to ourselves.

It's "physical distancing" NOT "social distancing"

40 INSESSION APRIL 2021

41 INSESSION APRIL 2021

COUPLES IN CRISES DURING COVID Over the past 12 months Covid-19 has created a lot of confusion and a firestorm of adjustments impacting couples and marriages at an unprecedented level. Anxiety and depression problems have skyrocketed due to job losses, losing friends and family to the disease, social isolation and the fear of contracting the virus. Anxiety and depression searches on Google since March of 2020 are at all time highs. For those searching for solutions and answers to a situation we never saw coming has stretched their ability to adjust to their mental limits. There is a mountain of stress that comes with a pandemic of this magnitude.

Personal stress combined with pre-existing relationship issues are creating complex problems on the homefront. Working from home while trying to school children virtually creates competition for time and resources.

Parents are being pulled in different directions and looking for some personal time has become nearly impossible. This potentially puts one or both partners in a marriage in jeopardy as “couple time” has become abandoned for the sake of finding personal time. The question is how do we sort all of this out and still have some sense of a decent marriage or relationship left?

The answers are not easy. Counselors are faced with new dynamics and having to reach outside the traditional therapy box to try and help those who are desperate for solutions. As the pandemic goes on, the pressure builds and the problems seem to be getting worse. Feeling trapped and stuck, partners are finding creative ways to get out of the home and seek some “me” time any way they can get it.

Unfortunately this time spent outside the family and home can lead to even bigger problems such as substance use. In addition to anxiety and depression there appears to be an upturn in affairs as well. An increase in marital affairs during a pandemic may seem contradictory, but it’s happening. There seems to be an increase of high risk behaviors on top of high risk behaviors.

Relationship problems are becoming more severe with domestic violence and a feeling of despair that client’s lives are completely unravelling. For example, infidelity has increased as relationships break down.

Partners are seeking connection with someone who may be sympathetic to emotional disconnection from their primary partners.

Additional stressors such as financial pressures puts strain on living conditions aggravating an already volatile situation. Counselors are conferring with each other looking for answers and coming up empty. We are in uncharted waters and some sessions are quickly becoming learning lessons for counselors and clients alike.

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Couples spending more time at home together is magnifying undesired behaviors. Irritating partner habits that were once overlooked are now building in intensity and boiling over. The emotional space needed to clear out their heads after having a conflict has been significantly reduced. Anyone who has done couples counseling can testify how the presence of a partner in the room can trigger explosive arguments. The confined space of a counselor’s office demonstrates how not being able to get away from each other can lead to ongoing conflict. In session counselors can act as a conflict mediator reducing argument intensity. The same is happening during the pandemic. There isn’t enough space to allow for emotional regulation. The places that once provided familiar healthy outings have closed or require strict adherence to Covid protocol which has effectively eliminated the enjoyment one would get from a routine coping mechanism. Activities such as playing sports, a gym, shopping or a simple restaurant outing with friends and family have become tricky.

Couples feel stuck and stressed out.

Limited coping strategies for these problems can only go on for so long. Things such as going for a walk, reading a book, exercising or listening to music usually work just fine in usual circumstances. But these aren’t usual times and these self soothing practices are much less effective, especially when the source of irritation is living and working next to you.

Couples can feel like they are being forced to like the displeasure of being stuck together too much. They feel trapped with no way out caught in some kind of existential intrapersonal experiment. The result is that arguments increase in intensity and frequency. The character of each person becomes more apparent to the other until finally someone decides they don’t want to be married to the other and files for divorce or starts an affair.

One or the other starts looking for excuses to get out of the house. They are meeting people online and then meeting at the local coffee cafe or some other venue trying to find a sense of

connection to someone. In some cases it can sound like pure acts of desperation. The survival part of the brain is in full swing.

So what is the answer? How do we get out of this locked down, feeling trapped and disliking the other person’s habits way of life that went unnoticed before? For counselors, it can be useful to borrow a play from the Dialectical Behavior Therapy (DBT) playbook. It’s important for couples to recognize their relationship is getting really stressed. When they can learn to go low and slow they can observe and learn triggers that lead to negative feelings. Part of this is behavioral chain analysis. A mindfulness approach can also be helpful in identifying future pitfalls. Using DBT techniques help the couple to emotionally regulate as well identify and heal broken parts of the relationship.

Couples also need to understand where each other is coming from in terms of how they react to the pandemic. One might be fearful while the other thinks it’s no big deal. Just like other couples counseling different worldviews and biases need to be taken into consideration.

To get through any difficult time it requires teamwork, sharing of responsibilities and a meeting of executive level thinking in order to make the relationship run smoothly. There needs to be a negotiation process to discuss things such as expectations of how to run the home with new changes happening. Decide who cooks, cleans certain assigned areas of the home and who grocery shops, sharing time taking care of the children and who is going to pay the bills. And don’t be afraid to mix it up and change out the areas of responsibility as needed. And if at all possible, get creative and find a way to make it fun.

Covid has created a crisis for couples with a lot of dichotomous thinking. It’s important for the couple to not forget how to love each other. It can be something as simple as date night. This doesn’t mean running out and risking exposure at a restaurant, but ordering food delivered, watching a movie and relaxing together. If you 43 INSESSION APRIL 2021

have kids perhaps set them up in another part of the house while you have date time for a few hours. Let the kids know what you are doing, they will probably love you for it. Nothing says stable home like two parents who love each other and want to be together. Parents who demonstrate love for each other give children a sense of safety and stability in the home.

Written By: Brian Murray, LMHC Brian Murray is a Licensed Mental Health Counselor at The LifeWorks Group in Winter Park FL. He specializes in Relationship Issues involving Codependency, Borderline and Narcissistic Personality Disorders.

FMHCA

R E S O U R C E

H U B

Submissions sent in by other Mental Health Professionals Pandemic Parenting Support Group, every Tuesday 6pm, zoom 933 6273 2214 Book: Now, Discover Your Strengths. Includes the Clifton Strengths assessment.

Calm App Counselor Toolbox with Dr. Dawn Elise-Snipes The Bright Feats directory (in print and on-line) which is a free directory of services for families of children with special needs. It is the only such directory in existence.

The Tapping Solution App GRASP - Grief Recover After a Substance Passing at grasphelp.org Universal helpline: 211 “I am” app Headspace app Want to see more or have your own resource you would like 123 Magic (Book) to share? Take a look at our FMHCA Member Forum* *must be an active FMHCA Member

44 INSESSION APRIL 2021

45 INSESSION APRIL 2021

PANDEMICS,

COCONUTS,

AND THE QUIET CRISIS It’s hard to wrap our minds around the notion that it’s been a year since the Pandemic washed over our world, vastly turning our lives upside down. At times, it feels like groundhog’s day in regard to the redundancy. I just read a news article claiming that grocery stores are beginning to feel the second wave of “panic shopping” as “another wave” of COVID-19 embarks on its steady rise. Sigh. Haven’t we read this chapter already? Wasn’t that in level four of the game of Jumanji we have been forced into this year?

This is where I typically see the color draining from my client’s faces, the fidgeting uptick, and the tears gathering in the corner or their eyes.

Throughout this processing journey there are hints of the shame, exhaustion, and loneliness these brave teens are carrying. The burdens that have yet to be spoken about or validated.

There is a name for this, folks.

There is a theme that has been becoming ever more prevalent within the therapy room. A theme that seems to be the quiet crisis that “panic shopping” has dominated. A crisis that is not only consuming our youth, but perhaps most humans along their journeys.

All real experiences that not only our youth have been subjected to, but all of us as a collective human-whole. Suddenly, our passions have been exposed to trauma. While living day in and day out for months with increased experiences of fear, anxiety, and grief of loss, we have been left to our own devices. The activities that used to bring us peace seem to highlight the feelings of unknown and of existing in an out-of-control world.

The passions that perhaps once provided a sense of identity and security suddenly seem lackluster and there is a void in motivation to engage in them. Once zealous artists are looking at their sketchbooks and cringing. Once creative chefs are allowing their mixing bowls to collect dust as they settle on their 6th frozen meal in a row and indulge with Netflix blaring in the forefront.

This experience of avoidance has many of our youth, predominately our older teens, spinning.

College applications are begging the question “Who are you?” and many of our aspiring college students are looking at their sketchbooks gathering dust in the corner and realizing “I have no idea who I am anymore”.

The pressure to define yourself, morals, values, and passions amid this year’s game of Jumanji can be overwhelming. We’ve been frozen in survival mode for so long that we are merely left with hazy memories of what life used to be.

Trauma. Burnout. Chronic emotional and mental fatigue.

Imagine that throughout your life, you develop a love of coconuts. You loved when you would find one at the store or indulge in a coconutriddled treat. One day, a giant storm came out of nowhere and swept you off against your own choosing to an island. You were confined to this island until an unknown time. However, it was overflowing with coconuts! Silver-lining in the crisis. Days pass, and the indulgence in your favorite thing is fantastic. It helps distract you from your confinement, your anxiety about the future, and your loneliness. However, as the acute stress morphs into chronic longlasting stress, you grow more and more detached from your love of coconuts. By the time you have an opportunity to leave the island, you never want to look at a coconut again.

46 INSESSION APRIL 2021

That’s where our youth are. There is trauma associated with the coconuts in their lives.

When they think of what used to light a fire within them, whether it be art, cooking, basketball, you name it, it is now associated with the trauma of state-wide lockdowns, loved-ones dying, and missing out on proms and birthdays. Thankfully, there’s hope.

I want to encourage our teens, and honestly all humans right now to let themselves off the hook. Normalize that you’ve had one too many coconuts within a traumatic experience and that you need a break. It’s OK to not have inspiration to pick up that paintbrush or bust out the mixers.

Use your time to create a list of activities or things to try for kicks and giggles. Aim for something novel and random that encourages endorphins and positive memories. Whether it be rock climbing, walking on the beach, or hot yoga; pack away the paint brushes with a “see ya later”.

Then, when you’re ready (and you will know when you’re ready), re-introduce yourself to those coconuts. Those ingrained passions, but at your own time. Redevelop that positive relationship on your own terms. This will not only empower you but inspire you to become grounded that you are still, and have always been, uniquely you.

So, how do we get back to what we love?

Written By: Katherine Scott, LMFT Katherine is the Licensed Marriage and Family Therapist at Puzzle Peace Counseling in NE Florida. She specializes in working with those on the Autism Spectrum and their families. She embraces an experiential approach with her clients in pursuit of healing.

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47 INSESSION APRIL 2021

48 INSESSION APRIL 2021

IMPOSTER SYNDROME: QUESTIONING YOURSELF DURING COVID The past twelve months have required all of us to reinvent the ways in which we relate to our jobs, and to do so quickly, as our homes, work, entertainment, and relaxation suddenly blended into one space. This unexpected, and sometimes messy, fusion has left many people questioning themselves and feeling unable to keep up with the different angles of pressure. As quickly as the lockdowns took effect, self-doubt was armed and ready.

What is imposter syndrome?

Anyone new to a career understands imposter syndrome. Doubting our abilities and feeling insecure in our new roles. We may not feel as capable as we actually are or as evidence has shown us to be. As therapists, we know about imposter syndrome very well. We start off in our careers feeling out of place and wondering how we could possibly be enough for our clients.

There are many reasons why even seasoned therapists’ imposter syndrome may be flaring up during the pandemic. COVID hit and therapists around the world were required to hastily turn their in-person practices to telehealth. We had to find HIPAA compliant methods of video conferencing, receiving payment, and securing our internet connections, amongst other technical challenges. I often say to people; I’m good with feelings, not technology. But whether comfortable or not, our clients needed us to act as if we were, and fast.

We also began supporting clients through a shared trauma. Every single one of our clients, our family members, our friends, and ourselves have been experiencing the same global pandemic. We are counseling clients through the fear, confusion, and unpredictability that we are currently going

through. If there was ever a time that we could relate to our clients, it was now.

Just like many of our clients, we probably had a difficult time managing our personal lives during the pandemic. Just like our clients, our families may have faced financial struggles, illness, death, or navigating our living situations, etc. Our own nervousness, worry, sadness, and emptiness may have spiked.

Perhaps we had our own mood swings and couldn’t manage our frustrations. How could we hold it together for our clients when we don’t know if we can hold it together for ourselves? Feelings of self-doubt creep in and we begin to feel like a fraud. It’s no wonder that we’re left questioning if we’re actually well-equipped at our chosen profession.

So what can we actually do to move through these feelings of not being goodenough?

Like we tell our clients, let’s start by gently normalizing these feelings of self-doubt and understand that everyone is riding these waves right now. These feelings are especially natural considering that we’re facing a completely unknown and unprecedented situation. None of us have ever had to reinvent our practices in the face of a global pandemic. Whether or not we have been 49 INSESSION APRIL 2021

practicing online previously, this is a whole new world.

Continue accepting these insecurities with radical self-compassion. In our profession, which is one of human connection and energy exchange, WE are the tools of our trade. There is an input and output of energy transferred between us when we sit with clients. We take on their emotions and our own emotions come into play in this relational work. If we’re hating on ourselves for not being ‘our best selves,’ it makes our jobs even more difficult. As we have compassion for our hardships, we allow space for our emotions to keep moving instead of staying stagnate. Let’s create space for ourselves to come as we are, just as we do for our clients. This may not mean that anything actually ‘changes’, it just means that we’re with ourselves and maybe we ruminate and beat ourselves up a little less.

We are people that help people and we also that need same help. Make sure to keep your own therapy sessions. Stay connected with your colleagues. Use your supervision and case consultation to receive clinical support.

We need to turn to each other to remind ourselves that we’re not alone in these feelings. As we remind one another, it will become easier to remind ourselves, that we are working pretty hard and doing the best we can. And if we are finding that the weight of all of the obligations is becoming too difficult to keep up with, make sure to have a safety plan in place with your closest supports.

The trick of imposter syndrome is that it makes us feel like we are the only ones experiencing it. We begin to doubt ourselves and our skills. Layers of different variables challenge our sense of self. A global pandemic will certainly prove challenging for anybody, including therapists. Balancing out the insecurity pendulum takes a bit of action but it need not be intense. Gentle prompts of what we are accomplishing will help train the mind to focus on what we can do. Connecting with our colleagues will help us realize we’re not alone in questioning ourselves. And continuing to be kind and compassionate to ourselves, is the undercurrent that will allow us space to keep moving forward, together.

Written By: Brooke English, LCSW Brooke English is a licensed clinical social worker and registered yoga teacher with over a decade of experience. She is in private practice remotely in FL and NY. Brooke specializes in seeing clients who have experienced trauma, specifically domestic violence or intimate partner violence. Brooke collaborates with her clients using holistic, energy-based somatic techniques to help them feel safe and empowered in their bodies and choices. Learn more about Brooke at www.bwellwithbrooke.com 50 INSESSION APRIL 2021

51 INSESSION APRIL 2021

BEHAVIORAL HEALTH: THE STIGMA OF REACHING OUT This article is for all “Mental Health Specialists” and the helping professions, to reach out to potential clients who are experiencing resistance in getting Behavioral Health Services. The term Mental Health (the term being changed with the focus maintaining on the positive) remains resonate with stigmatism because it still implies that there is something wrong with you “mentally”. Whether it be Psychologically or Cognitively, it implies that your brain, your mind, your thinking is “wrong”; just as it did when we used to say “Mental Illness” Then we began using the term “Emotional Health”. At the present time, we say Behavioral Health.

If someone is physically sick, it does not imply blame, unless you are a smoker but that is another story for a different article. However, when someone encounters the terms Mental Health, Mental Illness, Emotional Health, Emotional (implied) Illness, there is something uncommonly wrong. You have opened yourself up to an entire area of dark forces and are not capable to make your own decisions.

As therapists, we know this is not true. But, for the general public, the damage done throughout years of history causes many people to avoid seeking help. If and when they do seek help, they may be at their worst point in the process of emotional instability and may have symptoms that are more out of control then they would have been, they may be less inclined to seek help without some sort of mandate or they may be suffering from a tragedy that could have been avoided if they had sought help in the beginning.

People are afraid for a variety of reasons and history tells us that there was call for these fears. Look at our history. We, as a society,

hung people for having different beliefs. We burned people who were accused of being witches. We put people in “snake pits” and detained them from ever seeing society again. We abused people in facilities. We forced people to have electric shocks and lobotomies. We put children away for being deaf; mistakenly identified as mentally impaired. We have put people away for long term and irreversible depression that actually had thyroid disease. We have labeled children in schools as special education (for problems that in many cases, were not due to cognitive delay) and aside from the fact, that they were never able to obtain a full academic and social education, those labels stayed with them throughout their lives.

We, as a society are not that far away from those practices. In 1972, Geraldo Rivera broke up the horrendous situations going on in a State facility in Staten Island by bringing it to Public attention. That was less than 50 years ago. I remember watching it on Black and White Television (and even with the snow) it was appalling. However, we, as a Profession, must maintain accountability to continue to follow the laws that have been put into place to maintain people’s rights; regardless of age, gender, religion, culture , socioeconomic status and color.

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Currently, there are many people who are still afraid of what is happening to them and their own inability to control their lives much less let an outsider know what is happening. This is not to mention, that right now, in current times, people who have either social standing or dominant figures in the family, are able to get people “committed” against their will. We have parents who have their children declared as special needs so they can collect funding. We have abuse in some facilities and we most certainly have neglect. We have people who are working within the helping professions who abuse their power for personal gain. I have encountered it. I am sure you have as well.

We still have a historical Pandemic going on and we face Political pressures that are unprecedented. People are deathly afraid of getting sick; potentially dying. People have lost loved ones to the virus; people are suffering economic loss. People who had issues with coping before are now being triggered by the state of the world and yet, the experience has been politicized. We, as Behavioral Health specialists, must reach out.

Written By: Dawn M. E. Picone, Psy.D, LCSWR, BCTMH, QCS Dr Picone is a Board Certified Telemental Health Provider, Psychologist and Licensed Clinical Social Worker. Now, practicing exclusively online, Dr Picone states that she has been working with Covid 19 survivors, clients who have lost family members to Covid 19 as well as the associated anxiety of what’s happening in our world since the Pandemic started.

https://www.gemartstudio.com/

53 INSESSION APRIL 2021

SELF-CARE STRATEGIES FOR COUNSELORS DURING COVID-19 It is critical for mental health therapists, counselor educators, clinical social workers, and helping professionals to maintain wellness and take care of themselves, just as they teach their patients, clients, and students. Helping professionals often experience compassion fatigue if they abandon their self-care.

Self-care is a core component taught and preached within the helping profession. In pressing times or significant life events, the concept becomes even more germane and requires implementation. Helping professionals are navigating a new reality since Covid-19. Conceptually, we know that with life comes challenges, and the only constant is change. However, we are in unchartered waters. For over a year, counselors, specialists, patients, teachers, and understudies have experienced a challenge with our quality of life due to Covid-19 and its numerous deplorable and annihilating impacts. Therapists are experiencing stress, anxiety, and fear of the unknown, just like the clients they help. It is challenging to embrace and understand the new normal as we attempt to acclimate to the perpetual and constant safety measures as the Covid-19 research unfolds. We have learned that no one is immune to the wrath of Covid19, as witnessed on the news reporting the social and economic impact relatable to unemployment, working from home, education, homeschooling, and the spread of the virus. Consequently, the damages of Covid19 are disproportionately affecting African Americans and other racial, ethnic, and cultural communities, such as American Indian groups, at a higher rate. Contributing to the higher prevalence surrounds underlying mental health issues as a guide to assessing the impacts.

Mental health, wellness, and mindfulness have been a mantra of the helping profession and echoed from diverse disciplines and voices, especially in the wake of Covid-19. As an example, as reported by the CDC, beyond the physical spread of Covid-19, it can indirectly affect your mental health. Granted, for this moment in life, counselors can feel a little overwhelmed, and sometimes we have to be reminded of what we know to achieve the very thing we want for others, for ourselves. Hence, here is a little push to remind you. According to Section C.2.g. of the American Counseling Association’s Code of Ethics, “Counselors monitor themselves for signs of impairment from their physical, mental, or emotional problems and refrain from offering or providing professional services when impaired…” In this light, it is imperative to consider proactive approaches to maintain wellness.

Further, about life and to remind you, for counselor educators and mental health counselors, consider the whole situation of the stress of virtually (online) working from home on multiple days on end, up to 12 hours per day or more. Zoom or other video conferencing platforms, the new normal, have replaced faceto-face sessions and are now used to provide telehealth, teletherapy, and teaching online.

Zoom Fatigue is another form of burnout observed after incessant hours engaging in virtual sessions, meetings, consultations, and classrooms. Paying attention to the stress on how we, as counselors, process information over a video, there is a secondary effect on the body. Often, we are sitting at the same spot for an extended time. The stress still occurs when the camera is off and muted. Much is discussed about proper self-care for helping professionals during “normal” times. Counselor educators and counselors often experience compassion fatigue, burnout, and secondary or vicarious trauma. In the era of Covid-19, these symptoms are exacerbated due to increased caseloads, long hours, telehealth, collective anxiety about the pandemic, social justice and unrest in the country, and the political climate in the United States. America is experiencing 54 INSESSION APRIL 2021

unprecedented challenges for over one year now that has claimed over 500,000 lives and warrants higher medical, psychological, and social services to meet so many suffering needs.

In this way, remaining inactive, sitting for long periods will affect your body. Wellness may be viewed from a holistic approach as we consider self-care strategies to include the mind and body and spirit. These may consist of breathwork, yoga, stretching, energy work, or consulting an expert in holistic and chiropractic medicine.

How can you practice self-care during these unprecedented times? Here are some simple tips you can do at home while you are teleconferencing and can share with your clients. Be the change that you want to see in others.

Simple Self-Care Strategies When Working Virtually ·Be proactive and plan to incorporate self-care daily, even if this means walking around the house, yoga, stretching, meditating, practicing mindfulness, relaxation breathing, taking a relaxing bath, listening to music, or doing an online exercise program with a Peloton or similar stationary bike. ·Prioritize your tasks so that you don’t overextend your time and energy. Do what’s most important first. Don’t take on tasks that could be delegated to an assistant or completed at another time. ·Create ways to stay connected with those you care about. Set up a family game night with an App such as Houseparty or a Zoom call, or another video conference. Meet family and friends at a park where social distancing and safety are easy to practice with masks. ·Exercise your prerogative to say no and protect your time. It seems that many online meetings are overused when an email would suffice. Stick to your schedule, organize your day according to your needs and what makes

to you. ·Create a separate wellness/quiet space apart from your workspace. Some are fortunate to have a home office, making it easier to separate work materials and create an ideal space.

Written By: Dr. Michele Mitcham, LMHC, NCC, CCMHC, CFM & Dr. Hassiem Kambui, LMHC, NCC, CCMHC, ACS Dr. Michelle Mitcham is an associate professor in the College of Education, Department of Educational Leadership and Counseling, Florida Agricultural & Mechanical University (FAMU).

She has 25 years of experience, including counseling, family mediation, family and human services, specializing in DEI training, Gottman couples counseling, and high-conflict divorce.

She has been a professor for over 15 years, a graduate of the University of Central Florida's Counselor Education and Supervision (CES) doctoral program.

Dr. Kambui is an associate professor in the College of Education within the Department of Educational Leadership and Counseling at The Florida Agricultural & Mechanical University (FAMU). His research relates to the understanding and application of African culture, race, religion, and values associated with African American mental and social development. He has been teaching and practicing counseling for the past 20 years in school and community settings.

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LEGISLATIVE UPDATE

The Florida Legislature is nearly halfway through the annual legislative session which began in early March. There have been a total of 2,992 bills filed and yet only 21 have passed. With session halfway over, it appears this year will result in fewer bills passing than in recent years. Much of this can be attributed to the COVID-19 pandemic. The Legislature is forced to focus more on how to stretch the state budget in a post-COVID world and less about political disagreements.

premises when a registered intern is providing services in a private practice setting. It would maintain the requirement that the registered intern must practice under indirect supervision.

FMHCA has been actively participating in the legislative process. In fact, FMHCA crafted bill language, attained bill sponsors in the House and Senate and is in the process of securing broad support for legislation that has a positive impact on LMHCs and the people you treat.

Specifically, FMHCA is spending this session (and perhaps next session depending on how contentious the bill remains) focusing on a two-part bill which does the following:

The regulation requiring that a qualified supervisor be on the premises only applies to private practice settings and the term “on the premises” has never been defined and therefore cannot be easily enforced. During the COVID-19 pandemic neither the qualified supervisor nor the intern was practicing in person for the most part, so these mental health counseling residents were forced to choose between treating patients’ critical mental health conditions and upholding the law.

1) HB 941/SB 818 would remove the requirement that a supervisor be on the

2) Additionally, Florida Law states that, for the purpose of administering court appointed

Background— Under current law, a licensed mental health professional must be on the premises when clinical services are provided by a registered intern in a private practice setting.

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forensic evaluations, to the extent possible, the appointed experts shall have completed forensic evaluator training approved by the department, and each shall be a psychiatrist, licensed psychologist, or physician.

Because of the confusion surrounding the term “to the extent possible”, some jurisdictions do not permit LMHCs, LMFTs, and LCSWs to conduct evaluations for the courts, regardless of their individual levels of expertise and training and despite that assessment, diagnosis, and treatment of mental disorders is within the scope of practice of all Chapter 491 licensees.

This bill makes it clear that mental health counselors who have undergone forensic evaluator certification are equally qualified to provide these services to the courts as the groups I listed previously. This change will significantly expedite the judicial process and provide better access to qualified health care professionals.

Status—these bills have a hefty journey ahead of them to pass the legislative process.

Each bill must be heard in three committees.

FMHCA will be hard at work lobbying these issues and will update you often as the bill moves forward in the process.

Another bill worth mentioning is SB 72, relating to liability protections resulting from COVID-19. The bill will protect businesses as well as some health care practitioners from frivolous lawsuits which could be brought forth in response to the pandemic. As of now, Chapter 491 licensees are protected in the current version of the legislation; however, there are many iterations and FMHCA is battling to keep its members protected and retained in the bill.

The Legislative Session is only 60 days long. A lot of the real work begins after session concludes. It’s imperative that the Mental Health Counseling profession advocate directly with the legislators by setting “get to know you” meetings in your hometowns.

FMHCA will be sending additional guidance outlining how to set meetings with your constituent legislators.

Written By: Corinne Mixon, DPL Corinne Mixon is a registered Designated Professional Lobbyist who has been lobbying statewide government in Tallahassee for 15 years.

Stay in the loop by following us on social media!

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BYLAWS, 2020 of the Florida Mental Health Counselors Association A Florida Not-For Profit Corporation Adopted: July 18, 1998 Revised January 29th, 2004; January 1, 2009; February 10, 2012; January 8, 2014; May 17, 2014; September 10, 2014; June 8, 2015 Table of Contents ARTICLE I: NAME and PURPOSE ............................................................................................................... 2 Section 1. Name .......................................................................................................................... 2 Section 2. Affiliation .................................................................................................................... 2 Section 3. Purposes ..................................................................................................................... 2 Section 4 Annual Meeting ........................................................................................................... 3 ARTICLE II: MEMBERSHIP ......................................................................................................................... 3 Section 1. Types of membership ................................................................................................. 3 Section 2. Requirements of membership ..................................................................................... 3 Clinical Member .......................................................................................................................... 3 Regular Member ......................................................................................................................... 4 Retired Member ......................................................................................................................... 4 Graduate Student Member ......................................................................................................... 4 ARTICLE I: NAME and PURPOSE Section 1. Name This association will be known as the "Florida Mental Health Counselors Association“ hereafter referred to as FMHCA. FMHCA is incorporated in Florida as a 501(c)(6) corporation.

Section 2. Affiliation This association is a State Affiliate of the American Mental Health Counselors Association (AMHCA), and is recognized by AMHCA as the association to represent mental health counselors in Florida consistent with the Purposes as set forth in Article I, Section 3. Both AMHCA and FMHCA are independent and autonomous professional associations.

Section 3. Purposes The purposes of FMHCA are to: ·Promote the profession of mental health counseling; ·Provide a system for the exchange of professional information among mental health counselors through newsletters, journals or other scientific, educational and/or professional materials; ·Provide professional development programs for mental health counselors to update and enhance clinical competencies; ·Promote legislation that recognizes and advances the profession of mental health counseling ·Provide a public forum for mental health counselors to advocate for the social and emotional welfare of clients; ·Promote positive relations with mental health counselors and other mental health practitioners in all work settings to enhance the profession of mental health counseling; ·Contribute to the establishment and maintenance of minimal training standards for mental health counselors; ·Promote scientific research and inquiry into mental health concerns; 59 INSESSION APRIL 2021

·Provide liaison on the state level with other professional organizations to promote the advancement of the mental health profession; ·Promote the utilization of empirical or scientific foundation for the selection of mental health counseling techniques, procedures or psychotherapies; ·Contribute to the reduction of client harm by encouraging mental health counselors to explain the potential risk and ethical considerations of using "unproven" or "developing" techniques or psychotherapy procedures with no scientific bases; ·Contribute to the understanding of individuals from different cultural backgrounds within our diverse society by considering dimensions such as culture, ethnicity, nationality, age, gender, sexual orientation, mental and physical characteristics, education, family values, religious and spiritual values, socioeconomic status and unique characteristics of individuals, couples, families, ethnic groups and communities; ·Provide the public with information concerning the competencies and professional services of mental health counselors; Promote equitable licensure standards for mental health counselors through the state legislature; and to ·Address institutional and social barriers that impede access, equity and success for clients through ongoing advocacy efforts.

Section 4 Annual Meeting A meeting of the membership will take place annually. The agenda for such meeting will include a review of the Association activities and accomplishments in the past year, financial report, legislative activities and ratification of any bylaws changes previously approved by the Board of Directors.

The Annual Membership Meeting will be called to order at the Annual Conference when held, otherwise by electronic media. A quorum at the Annual Membership Meeting will be the members present.

Notice of the date and time and method of attending the annual meeting will be sent to all members by email where possible, otherwise by notice in FMHCA’s online newsletter.

ARTICLE II: MEMBERSHIP Section 1. Types of membership There will be four types of membership: Clinical, Regular, Retired and Student. All four categories of members may vote at meetings of the membership.

A member is in good standing who has applied for membership in the type for which they qualify, has paid the applicable dues and remains current on organizational dues. Members will remain in good standing unless dropped from membership under a provision specified in Section 4 of this Article.

Section 2. Requirements of membership To qualify for membership, an individual must meet specific requirements for the category of membership sought, as follows: Clinical Member Eligibility: Applicants for clinical membership must document that they meet entry-level standards for professional recognition as a mental health counselor by 1) holding licensure in Florida as a mental health counselor, holding status as a Registered Intern or 2) holding approved status as an applicant for licensure examination. Anyone who qualifies for Clinical Membership must apply for membership in that category.

Procedure: A person becomes a clinical member of FMHCA upon demonstration that professional requirements have been met and their initial dues have been paid.

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Obligations and Privileges: A clinical member must pay annual dues, and must adhere to the referenced professional Code of Ethics. A clinical member in good standing will be entitled to attend and vote at membership meetings of FMHCA, to hold office in FMHCA and may enjoy such rights and privileges as may from time to time be offered members.

Regular Member Any person whose primary work related responsibilities are in mental health counseling or a related clinical practice will be eligible for regular membership in FMHCA. Regular members may attend and vote at membership meetings of FMHCA, and will not be eligible to hold office.

Agency Member Defined: The goal is to assimilate as many public, private, non-profit and for-profit mental health and substance abuse treatment centers and programs, and community mental health centers. FMHCA will achieve this through an established scaled fee schedule for these agencies based on the number of employees they have - each entity to have one vote.

Retired Member Any person who has completely retired from active practice as a licensed mental health counselor, or a professional equivalent from a state other than Florida, will be eligible as a Retired Member. Retired clinical members may attend and vote at membership meetings of the Association and will be eligible to hold any office in the Association with the exception of President or President-elect.

Graduate Student Member Academic Requirements: Any student enrolled in a graduate program for half time or more (as defined by his/her college or university) in mental health counseling or a closely related field in a regionally accredited college or university will be eligible to become a Graduate Student Member of FMHCA. A member must be certified by his/her major professor as meeting this requirement. Graduate Student members may vote at membership meetings: they will not be eligible to hold office in the Association.

Section 3. Dues Annual FMHCA dues will be established by action of the Board of Directors in accordance with these Bylaws and will be collected by the FMHCA Treasurer, or by such administrative person or organization as may be designated by the FMHCA President.

Section 4. Severance of Membership A member will be dropped from membership for any conduct that tends to injure FMHCA or that adversely affects its Bylaws or the referenced professional Code of Ethics. A member will be dropped from membership for: · Nonpayment of dues; · Falsely documenting that membership qualifications have been met; · Having been disciplined by the 491 board, or · By action of the Ethics Committee and Board of Directors.

ARTICLE III: Local and Regional Chapters Section 1. Organization of Local Chapters The Association encourages the development of local Chapters to promote local interest and participation in the profession. New chapters may be accepted by the Board of Directors upon meeting the following criteria:

Click Here to Read Full FMHCA Bylaws 61 INSESSION APRIL 2021