Categories
Psychology

Could Group Therapy Help During the Pandemic?

Post written by B. Imei Hsu, RN-LMHC

Starting in 2020, I reverted to a protocol that I had not needed to enact in several years.

I began a waiting list. And I was not happy with that. Let me explain.

This is not a practice I have ever wanted for my community. From an ethical point of view, a waiting list can give a false sense of security to both the client and the therapist if there isn’t a set of guidelines and reasonable timelines that are communicated when a client makes requests for reasonable availability as well as suitability of a therapeutic alliance.

As people look for available therapists, they are running into the same challenge: most therapists in the Greater Seattle area are reporting that their schedules are full.

Don’t Give Up! It can be discouraging when you finally call to make an appointment, only to find out the counselor you so carefully chose has a really long waitlist or isn’t taking new clients. You might feel like it’s a sign you’ll never get the help you need, but that isn’t true.

From Open Counseling What to do when there’s a waiting list

The COVID-19 pandemic has changed the landscape of mental health therapy, and the waiting list has become an aspect of delivering mental health services. Many therapists made the transition from in-office counseling sessions to online sessions, and with a block of time that was once dedicated to commuting and maintaining a professional office, those extra hours were often transferred to client hours in order to help meet the demand for mental health services. Yet even with more counselors offering online counseling than ever before, you may still find that there is limited availability.

While it is left up to the discretion of the practitioner to determine how many client hours should be opened in their work week, my own professional ethics that help determine patient flow revolve around the following:

  • health of the provider and the provider’s ability to enact self care
  • the totality of the severity of issues of the typical weekly flow of clients
  • the amount of time needed to keep up with administrative tasks associated with the counseling practice
  • wiggle room for urgent issues and rescheduling

While it is it true that most therapists do not want to turn away clients when they are in need, therapists must triage clients seeking therapy and help refer them elsewhere when it is determined that the client is in considerable distress or crisis and needs more immediate attention.

Still, therapists only have so many hours a week that they can safely provide care to their counseling community. Overcrowding their schedule can cause client needs to go unaddressed; it can also cause burnout in the therapist.

And while individual counseling provides flexibility for clients to change days and times of time to suit their needs, it does not always help the provider to meet the overall needs of the counseling community.

During the past month, I’ve been leaning towards offering group therapy as a possible solution to the high demand for counseling in a time where most therapists, including myself, are at the top of their capacity with no end in sight. I find this ironic, because in the past, most clients declined group therapy because they viewed therapy as “me time” in which that time was seen as the hour in which each person could focus on healing.

The COVID-19 pandemic has changed how we see healing – not just as an individual process that occurs during “me time”, but as a process that happens within the context of relationships. After a year of isolation and distance, Group Therapy delivered via HIPAA compliant video conferencing may help to change the face of mental health services.

What has happened to us as a community because of COVID-19? Here’s just a few thoughts:

  • We have covered our faces – and part of our identities — in order to reduce the risk of illness and slow the spread of the virus.
  • We have physically distanced ourselves from one another, again for the same reason. This has caused widespread isolation and loneliness for adults and children.
  • Some have become mistrusting of one another in the absence of repeated socialization that happens in places of work, school, and activities outside the home such as shopping, playing in team sports, and even gabbing with others in the neighborhood
  • We have taken to more forms of one-way communication, especially after hours of sitting in front of screens for Zoom calls. Texts and other asynchronous forms of communication have taken over many of the interactions that require listening, patience, processing time, and the reading of body language to connect with and affirm one another.
Could Group Therapy Help During the Pandemic?

When I was first introduced to the concepts of Group Therapy, I saw it as the kind of therapy one did in the hospital during a very long stay due to recovery time, or a type of therapy created around a topic that was very specific and intense, such as Eating Disorder group therapy for a specific age group, such as teens to young adults.

While there isn’t a problem with this view, this perspective, in my own reflection, is limited. The reality of Group Therapy is that it is style of therapy that is appropriate for most people and most issues except for more severe forms of mental health issues. With a skilled group leader, a defined theme or content that helps clients select the group, and a clearly communicated beginning, middle, and end, a group context often allows individuals to progress through the phases of therapy faster than they might with individual therapy.

An additional bonus is that for the cost of the average group therapy session (around $45-50 a session), it is more affordable as well. Yet the intriguing part for us all is that a group may help therapists see more clients who need attention NOW versus having to wait weeks if not months for an available counselor. The counselor opens 1.5-2hours per week for 12 to 16 weeks, yet that time serves 12-15 clients who make the commitment to attend group therapy sessions until the group ends.

Finally, Group Therapy is often conducted with a co-therapist. This means that for the price of a group therapy session, each client has the eyes of two licensed mental health clinicians on them. I consider that “more bang for your buck”.

I enjoyed being a Group Therapy provider in the past, and I believe I would enjoy it again in 2021. The bigger question I have is this: will today’s client choose Group Therapy to meet their needs? If today’s client spends a couple of weeks trying to find an available therapist with whom they find some affinity, only to be told there is a waiting list that may be three weeks to one and a half months before an opening may be available, will Group Therapy be something people try if the group description is a good match?

These are questions I’m trying to answer before April 2021. If the answers start coming back in the affirmative, I’ll be advertising for group therapy clients soon. The hope is to alleviate the burden for people who have been searching for a therapist for a long time. And it would be my pleasure to invite a co-therapist who balances my therapeutic style with fresh thinking and other lenses in life experience.

Do you have comments about Group Therapy you would like to share? Feel free to reach out in the comments (and indicate if you would like keep your comment anonymous, as that is the default for me when I edit comments before republishing).

Categories
Psychology

Mindset Shift

In this New Year 2021, all of us across the globe have had to shift, adapt, and change as the pandemic slammed into large and then small towns across our nation.

And we are not done. As King 5 new‘s Brit Moorer discussed with me on camera where setting intentions fit within the path of a pandemic, I reminded our viewers that we are still in the middle of it. Instead of viewing the arrival of our first COVID-19 vaccine doses in Washington State as a sprint to the finish of this deadly virus, I reminded viewers to consider how riding out this pandemic safely is more akin to running a marathon than a sprint. And we are in the middle of that marathon, not the end.

With a marathon, you need to pace yourself. If you don’t, you hit the Wall and run out of energy to finish the race.

With people hitting “pandemic fatigue,” we are entering one of the most dangerous and deadly of times. Unfortunately, some people feel that nothing more can be done, and changing one’s behavior has little effect.

They are wrong. We have proved that if people follow the guidelines carefully to wear a mask when outside your home, stay socially distant from those who are not a part or your household, limit gatherings and avoid large public ones, and wash hands frequently, we can bend the curve of the pandemic wave and trend numbers of cases, hospitalizations, and deaths down.

We are close to seeing some light in this war against the pandemic, and it takes each one of us to take our social responsibility seriously. Yet to do that requires that each person change their behavior, and it’s this behavior change that has been the hardest part for us to bear. It requires that each person puts aside their individual freedom and rights in order to be a good neighbor.

In the later part of 2020, I rediscovered a song that I hadn’t heard for some time. Yet the lyrics are perfect for 2020, and for entering 2021 in terms of setting a mindset for change.

I’ve included the lyrics, below. May your mindset for change allow you to see the beautiful things amidst a difficult year.

Note: The SDC virtual office will be open again after January 12 2021. Due to a death in the family, office hours will also be changing.

*************************************************************************

Everything must change,
Nothing stays the same.
Everyone must change
Nothing stays the same.

The young become the old,
Mysteries do unfold.
‘Cause that’s the way of time
Nothing and no one goes unchanged.

There are not many things
In life you can be sure of.

Except…
Rain comes from the clouds,
And sun lights up the sky,
And humming birds do fly.


Winter turns to spring.
Wounded heart will heal.
Never much too soon
Everything must change

Rain comes from the clouds,
And sun lights up the sky,
And humming birds do fly.

[George Benson]



Categories
Change Psychology Resilience Rest

Is It Too Soon?

This is an opinion piece written by the owner of the Seattle Direct Counseling website and blog.

Have you come across a question on Social Media that asks you to share positive things you have experienced due to the COVID-19 pandemic?

Before I do some research as to what other people in the field of psychology think about this question, I tuned into my own feelings. Mine are obvious, and you are free to disagree, yet I would ask you to read the entirety of this post and take a breath before you respond.

Nope. It’s too soon for me to share a list of silver linings. There are still people getting sick, still people dying, and still people grieving the loss of their loved ones because of COVID-19. There are still people who have lost their jobs or who are still bouncing back from economic hardship. There are still people getting evicted, moving because they can no longer afford their homes due to job loss, and still having difficulty making ends meet. There are still children and parents struggling to juggle in-person, remote classrooms, hybrid versions, and work-life balance. There are still essential workers from groceries to healthcare that are burned out, overworked, and traumatized by the care and servicing of sick, frightened, angry, and sometimes selfish people, all while they grieve the loss of fellow colleagues.

This is not to say that I haven’t seen or heard people experiencing many positive changes in their lives this year. Yet the question wasn’t just about positive changes. The question was about making a direct correlation between a pandemic – that has the potential to kill 20% of the population regardless of health history, decimate whole family systems with its easy transmission through secretions, and disable world economies for a number of years – with positive benefits.

I believe the question was intended to get people thinking about gratitude. The other potential meaning behind the question is what I find troubling.

I find that we’re often asked to make a list of positive outcomes when we’ve gone through a tough time. The problem is this: the tough time hasn’t ended. With the coronavirus out of control in many countries around the world as well as right here at home, it feels too soon to ask people to conjure a positive attitude or to list what good things they have experienced since the pandemic hit their respective towns and cities. It’s like asking people to diminish the real pain and hardship they have experienced, put on a smile, and move on, without getting to the real deal behind trauma and adversity.

If Not Silver Linings, What Else?

Is there something helpful to focus on besides silver linings and gratitude lists in the midst of difficult times, especially if you actually tried to develop a more positive attitude and found that to be — well, not very helpful?

If I could wish anything for you now, it would be a combination of Rest and Resilience.

What I mean by Rest is a short break from the elements of your life that may be causing insomnia, heartache, loneliness, burnout, and financial strain. If the coronavirus is out of control in your town, getting rest is complex. I understand you can’t let your guard down. Yet Rest can come in waves, from remembering to take time breathing fresh air when you can step outside and away from crowded areas, to choosing to turn off your smart devices at least an hour before bedtime so your brain can go into recovery mode.

Rest can mean snuggling with your pets and household members, singing along with a song you love, connecting with a friend via Zoom, or quietly putting together a puzzle while silencing distraction and stress. Rest can mean you give yourself a break from trying so hard to make this year’s holiday celebrations look exactly like previous years, especially if the means to do that cost you or others more than you can afford or risk.

What I mean by Rest is that if you have time off from work for the holiday, take it, and take it seriously like it meant your life. Rest. Your mind and body need it. If you must create something to do, you can invigorate your mind through the Art of Doing Nothing.

What I mean by Resilience is the capacity through a developing pathway or routine to adaptation through adversity. It involves mental and emotional toughness that can be built over time by allowing yourself to feel and experience something difficult, and then acknowledging what you did and how it felt as you got through it. It’s the acknowledgement that you weathered something uncomfortable if not downright painful, and you did not die.

Resilience can look like you buying your first couple of cloth masks at the start of the pandemic, moving through your feelings about wearing them, learning how to make your own, and giving or selling masks to others to help others. The next time you find yourself worrying about the pandemic, you may also realize you have adapted your thoughts, emotions, and behaviors – “I am concerned, I feel myself feeling anxious, I remember to put on my mask when I must leave my house”- in such a way that that you feel stronger to face the day. Over time, this might even feel easier.

Resilience can sound like learning to be more clear and direct with your words and actions, beginning with loved ones and expanding to your interactions with co-workers and community members. When you note how the choice to institute healthy boundaries around your time and energy has a payoff for you despite the fear of disappointment from others, you could be developing the necessary resilience to handle the kinds of uncomfortable emotions and thoughts that build when handling aspects of what so many of us fondly refer to as “adulting”, only it can feel like Adulting on Steroids.

At its most basic elements, Resilience involves personal growth. At its height and breadth, Resilience allows you develop something I call Relentless Forward Progress. It’s that part of us that can become more than we thought (and not to be confused with productivity), allowing even trauma, adversity, illness, and accidents to shape us. We would never wish these events on anyone, yet at the same time, the resilience that people can develop from having gone through these things can be profound. For more on what psychological resilience is, check out this link.

If making a list of how you think you’ve benefited by the pandemic coming to your door makes you feel more hopeful and upbeat, I’m not saying you should stop making that list.

What I am suggesting is that it wasn’t the pandemic itself — a virus that can kill — that should be celebrated right now. Rather, it’s your adaptive responses to it — and all kinds of adversity — that deserves cake and a happy dance.

Categories
election anxiety Psychology Stress

Election Anxiety Actually

November 2016, I wrote a post titled Election Anxiety, just days before the election to help others name and address this non-DSM V set of anxious thoughts and actions tied to the hotly contested run for U.S. president.

The rest is history.

Until then, I had never experienced so many clients and community members taking the initiative to talk about their hopes and fears tied to the perceived outcomes they associated with each candidate. I was even interviewed on the local news about Election Anxiety. And now, in October 2020, we are here again: Election Anxiety, Actually.

Let me remind my readers, I am a Licensed Mental Health Counselor and a Registered Nurse (A-R) in good standing. As a matter of course, I do not initiate conversations about politics with my clients, nor is it any part of my therapeutic ethics to persuade, manipulate, validate, or dismiss the views of my clients.

What I do is assess how the world of my client manifests through actions, behaviors, thoughts, and feelings, all of which have positive and negative outcomes for them, their families, and communities.

If you haven’t already done so, I invite you to click on the link above and read my words from 2016, most of which apply today. And is there anything I want to add that could be helpful for this round of Election Anxiety?

You ‘betcha.

Election Anxiety on Steroids

If you experienced Election Anxiety in 2016, this year may feel like more of the same except on steroids. If you were angry, depressed, or frightened then, many of the same concerns are still on the docket in 2020: healthcare for all, racial equity, gender equity, the economy, immigration law, environmental concerns (public lands, national parks, natural resources, climate change).

Let’s add two more issues: 1) a global pandemic, of which the United States is among the top countries with high counts of COVID-19 positive cases and leading in the number of deaths from the coronavirus, and 2) racism as a pandemic (declared by Public Health as such), with ongoing violence and unnecessary use-of-force by authorities against BIPOCs as a whole (Black, Indigenous, and People of Color) and Black people in alarmingly higher proportion.

Our nation is divided, and not necessarily just along party lines, about how to address both of these pandemics. Across both sides of the aisle are those who feel that economic stimulation is the general answer to resolving the ills of systemic racism and keeping our countrymen/people intact. Granted, that means that a lot of people may die, but their argument is that they feel that the people who die from the coronavirus are generally older and have co-morbidities that would prevent a more straight-forward recovery from a coronavirus that preys on weakness. This let them die attitude does not take in account that the virus also kills young people and may leave many with chronic illnesses that don’t know how long it will take to recover, if at all. The SARS-COV-2 virus has disproportionately affected BIPOCs. And I am beside myself with grief the number of healthcare workers who have died while doing their job to save the lives of others during the pandemic.

Across both sides of the aisle, there are citizens who feel that the current administration has not been forthright about its stance against the coronavirus since the first day it hit the shores of the U.S. (and in the Greater Seattle area, no less). We have learned as a nation that the pandemic was downplayed. And despite efforts from healthcare workers like myself and local Public Health authorities to prepare our communities to mask up, wash hands, test if you have symptoms of the virus, stay home and stay healthy, initiatives to act as a nation was fragmented, left up to individual states to do as they felt best, to obtain PPE where they could, and to mobilize resources, volunteers, medical professionals, and institute strategic planning.

Some states did better than others. Yet as of Sept. 29, 2020 (date of this writing), the U.S. still has more than 20 states with increasing numbers of coronavirus cases.

If you ask why Election Anxiety is high again, it’s all the issues of 2016, and these two pandemics piled on top of them. Americans will be heading to the polls, mailing their ballots*, or placing their ballots in secure ballot boxes, answering the question of who they feel will provide the leadership to tackle the most deadly pandemic to hit us in over a century.

Bystander Trauma

As a clinician, I have been given few, if any, diagnostic tools, tests, or measurements to describe and treat what we are collectively calling Racial Trauma. There is no category for systemic racism in our billing codes for sessions. Yet trauma is trauma. Trauma has features that we can name, point to, and identify, such as:

  • Shock, denial, or disbelief.
  • Confusion, difficulty concentrating.
  • Anger, irritability, mood swings.
  • Anxiety and fear.
  • Guilt, shame, self-blame.
  • Withdrawing from others.
  • Feeling sad or hopeless.
  • Feeling disconnected or numb.

[Helpguide.org]

Among those who talk about Election Anxiety and Post-Election Anxiety, I see the same symptoms. The severity of symptoms can be off the charts when you add in the chronic cycles of systemic racism and the exhaustion of trying to fight against it for oneself, one’s children, and one’s community. For some families, the fight against racism can be traced back across hundreds of years.

Bystander Trauma is also real. We usually think of Bystander Trauma in the context of a first-responder who witnesses and attends to a victim of a traumatic event, such as a vehicle accident or a violent crime. Yet those of us who witness via Social Media, News Feeds, television, and radio broadcasts of traumatic events can also experience another type of Bystander Trauma. The exposure to seemingly endless news stories of violent acts done against BIPOCs, deaths of loved ones and community members to the coronavirus, and a conflicted and contentious election can stir up similar feelings of loss, anger, hopelessness, denial, hopelessness and helplessness.

You may not be left physically bleeding by any of this, but in terms of your emotional health, you might feel like someone has nailed a spile in your soul. If you find yourself asking why you feel so emotionally spent by the end of a WFH (Work from Home) work week, you may want to learn more about the effects of “witnessing” a firehose worth of news stories related to the elements that are shaping our current U.S. elections.

Because my 2016 post outlined some guidelines about managing Election Anxiety, I won’t rewrite them here. Yet what I want to make clear is that the answer isn’t found in turning away as much as it does in managing the stream while finding the balance with appropriate action.

Your vote matters. As many of us have seen for ourselves, what we do in one moment in time is remembered years later. Our words, actions, and thoughts — even our recanting, apologies, and amends for wrongdoing — make a difference.

And, if it’s time to turn down the volume and turn up the action — like taking care of your mental health, following up on your physical health, and advocating for the health of your family members, community members, and state, we’re here to help you do that with all the continuing education, skill, and care that is a part of our profession.

If you’re struggling with anxiety — and Election Anxiety in this particular season — we’re here to help.

______________________

  • It may be a felony to vote more than once in an election. If this has been suggested to you, please consider the legal ramifications and fines for doing so. https://www.ncsl.org/research/elections-and-campaigns/double-voting.aspx
Categories
Psychology

Coming Soon

August is my “reset” month for rest, reflection, and rebuilding.

We’re aware there are some debugging and admin issues on the website. Hang tight, the big clean up job is coming!

We’re still listed with Psychology Today, so if you came by here looking for more information on our services, please check us out on Psychology Today for more information.