Counseling students transition to telehealth while providing mental health services during COVID-19

As Marymount University and our society continue to find ways to adapt to the new circumstances of the COVID-19 public health crisis, students and faculty in the Department of Counseling are continuing to provide mental health services.
The clinical mental health counseling (CMHC) and pastoral clinical mental health counseling (PCMHC) graduate programs currently have 52 students who continued to work in their clinical placements during the spring semester, and quickly adapted to the telehealth demands of the pandemic. They have provided mental health services for a combined total of 12,480 hours to over 480 clients, while facilitating over 250 counseling groups. Their work has taken place in homes, outpatient mental health centers, retirement centers, hospitals and private practice settings.
Calls for social distancing meant counseling interns could no longer meet with their clients in person, so students switched to exclusively using telehealth methods. This shift has presented new challenges for mental health professionals across the country, but it is more important than ever for them to provide consistent accessibility and continued care for those who need it.
“Video counseling options through telehealth have allowed me to continue to provide care for my clients,” said counseling intern Lauren Stephens. “While it is a change and adjustment for both the client and therapist, I have continued to hold space for kids as they process COVID-19 as well as the ordinary parts of life.”
Counseling interns work with clients who are medical professionals on the front lines of the novel coronavirus crisis, as well as those who are unable to rely on their normal support systems, parents who are learning to take on additional roles for their children and with children who have lost important structure and social interactions in their daily lives. They help clients navigate times of loss in financial stability and careers, important milestone events like graduations and birthdays, connections with loved ones and the general absence of normalcy.
Caregivers have been forced to depend on others for the care for their loved ones. The grief process for many is delayed or complicated as clients are unable to visit loved ones who are ill or who have died. Clients with differing cognitive functioning levels, those who are already isolated in their communities and ones with existing mental and medical health conditions have had to deal with even more stressors.
“Stressors from residents have included death anxiety, not seeing family or being contacted by family and being frustrated with policy changes,” explained counseling intern Greta Christ, who works with assisted and independent living for older adults. “Our residents with dementia have had the hardest time, as they don’t quite understand what is happening.” 
While some states are moving towards lessening restrictions, it’s predicted that the mental health impacts from this pandemic are only beginning to show within communities. There’s expected to be an increase in suicidal thoughts and behaviors across the nation, and new populations on the front lines of the pandemic – whether medical professionals, first responders or clergy members – may require counseling and other supportive services.
“I have found a theme of my clients doing surprisingly well the first two weeks of quarantine, but then seeing a progression of symptoms with an uptick in depressive and anxious thoughts,” said CMHC intern Bethany Baker.
Marymount students have continued to meet with their faculty supervisors and classmates online on a weekly basis, while faculty have made adjustments to tele-supervision and modifications to supervisor requirements in order to meet privacy practices outlined for the counseling profession.
“My students found it challenging to adjust to the uncertainties of learning a new workplace, skills and clientele while also teleworking,” said Dr. Ioana Marcus, CMHC program coordinator. “Perhaps the most significant learning experience for all of us has been learning to live, work and support others staying grounded and resourced in the midst of uncertainty.”
The impact and demand of telehealth also has a price on the well-being and self-care of students who provide direct service, and the faculty who provide supervision for their clinical work. This means that mental health counselors, interns and clinical supervisors must integrate ways to make sure they practice self-care.
Caregivers may not take care of themselves as well as they take care of others. But especially now, they must take steps to maintain their own mental health as they walk through many of the same challenges as their clients during this difficult time. Secondary stress and vicarious traumatization may occur during telehealth for providers, and identifying early burnout in students has been a focus of faculty’s supervision of students.
“While many programs have seen a decrease in internship placements, Marymount’s Counseling department has confirmed clinical placements for 46 interns during the summer,” added department chair Dr. Lisa Jackson-Cherry. “Interns are the essential workers who often receive little recognition for their continued clinical work, and with no financial reimbursements. They are the ones who bring stability in this unknown and changing environment, safety to those who feel less safe and a sense of belonging and presence when the client finds themselves in isolation and alone. Marymount’s Counseling students are truly the unsung heroes in our community making a difference.”
This article was written by Dr. Lisa Jackson-Cherry (Chair, Department of Counseling) and Jennifer Stevens (CMHC Graduate Student Intern)