Covid-19 and The Counseling Profession: Effects and Implications for Practice

COVID-19 is a worldwide pandemic that has had a detrimental effect on all facets of our life. According to the literature, the effects of COVID-19 on mental health include higher anxiety and depression levels among the general population, adverse psychological impact on their daily livelihood, and higher domestic and alcohol abuse rates. As a result, there are major implications to the counseling process. This conceptual paper discusses the effects and implications of COVID-19 on the counseling profession. It includes the general effects of COVID-19 to the counseling profession and its implication for counseling practice and intervention especially for counselor practitioners and counselor education programs.

The Coronavirus Disease 2019 (COVID-19) is a pandemic that originated in Wuhan, Hubei province, China (Huang, Wang, Li, & Ren, 2020). The disease's symptoms include cough, fever, and shortness of breath. The virus spreads rapidly across the world from China, causing a worldwide pandemic that has greatly impacted the world population (Huang et al., 2020). However, one the most impactful effects of COVID-19 is on our mental health, causing great psychological stress, anxiety and loneliness among the world population (Batra, Morgan, & Sharma, 2020;Cicek, 2020;Jack, 2020;Mohammadpour, Ghorbani, Khoramnia, Ahmadi, Ghvami & Maleki,2020;Saffarinia, 2020;Sun & Ying, 2020;Vostanis & Bell, 2020). Saffarinia (2020) stated that COVID-19 has had multiple adverse psychological impact on individuals across the globe: fear of illness, fear of death, spreading false news and rumors, interfering in daily activities, restrictions on travel and transit restrictions reduced social status, jobs, financial problems, and other issues. This is supported by Vostanis and Bell (2020) who stated that the prevalence of mental health issues usually increases during times of difficulty. For example, it has been shown that domestic violence and alcohol abuse rates increase during the COVID-19 stay-at-home period (Bradbury-Jones & Isham, 2020). A global study by Gloster, Lamnisos, Lubenko, Presti, Squatrito, Constantinou, et al., (2020) found three common predictors in having an impact on mental health: low social support, lower psychological flexibility in dealing with stress and anxiety related to COVID-19, and lower education levels. In a tele-counseling service provided in Bangladesh, it was found that 87% of callers had psychological symptoms which include anxiety and sleep-related issues (Iqbal, Jahan, Yesmin, Selim & Siddique, 2021).
It also has major consequences on different group ages. In a study among Chinese university students, it was found that 67.05% of them had traumatic stress, another 34.73% indicated anxiety symptoms. While 46.55% showed depressive symptoms (Sun, Goldberg, Lin, Qiao & Operario, 20021). Among the elderly in the United States, it was found that the prevalence of psychological distress was higher post-COVID 19 (7.3%) when compared to the pre-pandemic prevalence (3.9%) (Batra, et al., 2020). This is further illustrated by Brown (2020) in a study conducted in the UK. After the stayat-home order was mandated in the UK because of COVID-19, it was found that 38% of participants reported significant depression while another 36% reported significant anxiety. Before the stay-at-home order was made, the number was at 16% and 17% respectively. Brown (2020) also found higher rates of anxiety and depression among those aged under 35, living in urbanized areas, those with lower incomes or with health conditions, and living alone or with children. Anxiety and stress levels are even higher for those who are already battling depression or obsessive-compulsive disorder (Phillips, 2020). Therefore, counseling becomes an important factor in promoting better mental health among the general population (Pandya & Lodha, 2021;Sun & Su, 2020). With the increasing mental health implications, COVID-19 has had a major impact on the counseling profession (Vostanis & Bell, 2020). Some of impact on the profession include issues in rapport building and therapeutic alliance (Selekman, 2021), difficulties applying counseling theories (Vostanis & Bell, 2020), trustworthiness (Hanley, 2020), internet or technological issues (Smith & Gillon, 2021) and lack of control (Henley, 2020;Smith & Gillon, 2021). In this article, we would focus on the effects that COVID-19 has had on the profession, mainly from a global perspective and a Malaysian context, and implications that it would have on the profession in the near future.

Methodology
This conceptual paper used 26 research articles on COVID-19 and counseling by using keywords and research area sourced from academic databases (EBSCOHOST, Science Direct, Proquest, and Google Scholar). Based on that, a literature review was written focusing on the effects and implications of COVID-19 on the counseling profession.

Effects Of Covid-19 on Counseling
There are many implications of COVID-19 towards the counseling profession. The first major effect are the higher anxiety levels among the population. As already stated in the introduction section, there are severe effects on the overall psychological state because of COVID-19 (Cicek, 2020;Jack, 2020;Mohammadpour, et al.,2020;Saffarinia, 2020;Vostanis & Bell, 2020). Overall, people are exhibiting more negative emotions (anger, anxiety, depression) and show less positive emotions after the World Health Organization (WHO) announced COVID-19 as a pandemic (Mohammadpour et al., 2020). As such, counselors need to be prepared to see more clients with anxiety and depression issues in the next year or so. It is important for counselors to be familiar with symptoms of anxiety and depression, and have the necessary skills to help clients deal with anxiety and depression issues. This will be discussed more in-depth in the next section.
Another major effect is the difference between gender in dealing with COVID-19. According to Mohammadpour et al., (2020), it was found that men are less likely to engage in self-care behaviors in handling with COVID-19. This can be seen where men are less likely to adhere to social distancing when compared to female. According to Mohammadpour et al., (2020), this is likely due to women having more concern about transmitting the disease to family members and because women have greater levels of responsibility in caretaking when compared to male. In a Malaysian context, a study by Sheela Sundarasen, Karuthan Chinna, Kamilah Kamaludin, Mohammad Nurunnabi, Gul Mohammad Baloch, Heba Bakr Khoshaim, Syed Far Abid Hossain and Areej Sukayt (2020) among university students in Malaysia found that female students have higher levels of anxiety when compared to male students. Therefore, counselors should be aware of the gender differences when it comes to their attitude towards self-care behavior and proneness to anxiety and depression, and could be a potential issue that needs to be addressed in a counseling session.
As stated earlier, stay-at-home order has led to many detrimental effects to individuals and the society. For example, for couples who have already had tensions in their marriage, stayat-home orders could lead to more issues including domestic violence (Brown, 2020).
Besides that, those who stay alone might also find it difficult when they do not socialize as they used to in normal circumstances. Brown (2020) calls this "the Corona catalyst" where new issues are cropping up based on the effects of stay-at-home orders and anxiety related to . Therefore, counselors need to be aware of this newly developed issue in the society and be prepared to help clients when they have issues that are related to the aftereffects of COVID-19.
Online counseling is also another major effect to the counseling process. It has come as a shock to most counselors around the globe as the pandemic has led to counselors having to rely on technology to provide counseling. Unfortunately, most counselors are ill-equipped to provide a good counseling experience due to a lack of training. Maurya, Bruce and Therthani (2020) in a survey study stated that only a small number of counselors previously offer any type of online counseling. In their survey of 193 counselors in the United States, they found that 80.8% (n = 156) reported to have never or rarely provided online counseling services to their clients, while only 5.2% (n= 10) use online counseling frequently. Results of the study indicate that counselors need to be more prepared in providing online counseling as a response to the COVID-19 pandemic.
Another study by Smith and Gillon (2021) discusses in-depth about two major issues for practicing counselors with doing online counseling: (a) environment adaptation, and (b) practice enhancement. With environment adaptation, Smith and Gillon (2021) found that a lack of control about what is happening in a counseling session had led to counselors feeling highly anxious about doing online counseling. For example, in mitigating risk involved in counseling, counselors reported being anxious about client's safety net especially if the client has depression or other severe mental health issues. For practice enhancement, counselors feel they have inadequate online counseling skills that has led to the development of new skills (Smith & Gillon, 2021). For example, listening skills has to be more enhanced as counselors have to focus more to what the client is saying to build a good rapport with their client. This is supported by Anjum Ahmed and Haya Firdous (2021) who stated that the lack of non-verbal communication in online counseling impedes the process.

Implications for Counseling Practice
The COVID-19 pandemic has had severe implications in terms of the service provided to clients. While the counseling process remains the same for the most part, the use of technology and the rise in anxiety-related issues need to be addressed by providing potential interventions that could lessen the impact. Jack (2020) stated that one of the most important changes that needs to be made is to normalize the anxiety experienced by clients. To do this, Jack (2020) recommended the use of psychoeducation to reassure clients that the protective measures put into place (ie: wearing mask, using hand sanitizer) is to keep us safe and that having some levels of anxiety is normal in these trying times. Reassuring clients that what they are going through in the extraordinary times goes a long way to help them deal with their COVID-19 related anxiety and stress. Jack (2020) also found cases where clients have anxiety because their family members and friends are not following safety precautions, which leads to stress because of the behavior of others. Jack (2020) recommended using Cognitive Behavioral Therapy (CBT) to help clients process this anxiety by helping clients focus on their own behaviors (follow social distancing, practice good hygiene) which in turn could help model appropriate behavior to their family and friends. By doing this, clients would learn that they cannot control the behavior of others, but by exhibiting appropriate modeling, it could influence people close to them to change their ways.
Clients have struggled with daily living because of stay-at-home orders, which limits outdoor activities and socializing. Therefore, counselors need to make sure that clients have proper coping skills so that they can cope with the new norms of living. Phillips (2020) stated that counselors can do this by helping their clients set small, achievable goals and take time to reflect on what they have accomplished each day. By doing this, clients would have something to look forward to each day and at the same time build new coping skills. For example, clients can have an internal monologue with themselves by asking, "What is one thing I can do today to move toward accomplishing my goals?". Phillips (2020) also advised clients to continue having a regular routine for as much as they can, especially with basic necessities such as waking up, taking a shower, eating and sleeping at usual times.
To reduce anxiety and depression among clients, Bray (2020 recommended using relaxation techniques in addition to other counseling techniques. Bray (2020) found that calming techniques such as meditation, breathing exercise, and mindfulness helps client to process and understand their emotions better. It also helps client to have better self-care, such as better eating and sleeping patterns, all important tenets in Maslow's hierarchy of needs theory.
To further reduce mental health issues, counselors can focus more on the spiritual aspects of the client. According to Bell, Crabtree, Hall, and Sandage (2020), the uncertainty in life has challenged the belief system of clients as they do not have the resources to cope with the inner struggle related to self-isolation. This leads to higher incidences of anxiety and stress as they do not have the mental fortitude and resilience to deal with multiple changes to their daily life (Vostanis & Bell, 2020). To improve this, strengths-based approaches such as mindfulness that fosters gratitude, humility and hope can enhance clients coping mechanism . The efficacy of mindfulness is supported by a study by Sun et al., (2021) who found that mindfulness is effective in reducing stress, depression and anxiety symptoms. In Malaysia, spirituality and religion can be used in addition to the calming and mindfulness techniques to help them manage their emotions better.
Addressing grief and loss is another important consideration for counselors. This is because there is an increase of individuals who would have lost their loved ones because of COVID-19. Litam and Hipolito-Delgado (2021) provide several guidelines when working with grief and loss issues for counselors. The first is the need for counselors to bracket their own experiences with COVID-19 so that the focus remains on helping the client deal with their own issue. Second, counselors must recognize negative thoughts that may lead to selfdefeating for the client. For example, blaming themselves for the loss of a loved one. And finally, counselors could encourage clients to celebrate important dates in other meaningful ways by utilizing technology use. For example, celebrating birthdays on Zoom.
There are also important implications to online counseling. According to Maurya, Bruce and Therthani (2020), counselor training programs should start to focus on teaching online counseling in their counselor education programs. There are two main components that are particularly worrisome for counseling practitioners: (1) ethical and legal protections for clients and counselors, and (2) factors and best practices for effective therapeutic interventions for online counseling. Therefore, it is hoped that the Board of Counselors Malaysia could come up with a code of ethics that could safeguard the online counseling process for both counselors and clients. Maurya, Bruce and Therthani (2020) also recommended that online counseling skills and practice be taught in counselor education programs after counseling students have already developed good counseling skills in faceto-face counseling. Therefore, it is hoped that counselor education programs in Malaysia follow suit by mandating this in the teaching syllabus moving forward.
Other recommended counseling practice include encouraging virtual community for clients. With reduced social engagement and limited mobility, clients are encouraged to socialize through virtual means as an alternative to traditional face-to-face meetings (Meyer & Young, 2021). For example, if a client would usually socialize through religious gatherings but are unable to do so because of COVID restrictions and concerns, then clients can be encouraged to move to an online-based gathering as it would still provide them with an opportunity to socialize with others. In fact, clients could also start their own virtual groups that is based on their interest or preference (Meyer & Young, 2021).
Counselors are also encouraged to provide online mental health workshops to help the community deal with lingering COVID-19 mental health issues. For example, in China "Peace of Mind" lectures were conducted in the Hubei province to provide help psychological assistance (Liu, An, & Wu, 2020). This includes online self-help training camps for the general population, for parents, and for frontliners. This view is echoed by Litam and Hipolito-Delgado (2020) who encouraged online workshops by counselors at no cost. The workshops could be focused on behavioral changes such as the benefits of exercises, the importance of continual socialization during self-isolation period, improving communication among family members, and much more (Litam & Hipolito-Delgado, 2021). By doing this in Malaysia, it could help the population cope much better with mental health issues associated with self-isolation.
COVID-19 has also changed the professions practice in more specialized counseling fields. In family counseling practice, Selekman (2021) proposed that families can start to implement changes in their relationships even prior to the start of the counseling process. In a usual family counseling practice, family assessment by using a system theory approach is done before an intervention is administered by the family counselor. However, a proper assessment process takes at least 3 sessions. To speed up the process, counseling interventions can be given much earlier. Selekman (2021) called this the Family Treasure Chest, where pretreatment changes are utilized even before the first counseling sessions starts. According to Selekman (2021), families can utilize current strengths in their family dynamics so that they are able to better cope with family issues. For example, parents could observe their children's behavior and list down positive behaviors exhibited by them. This can be brought to the next family counseling sessions to speed up the counseling process due to the pandemic.
In career counseling, Drosos, Theodoroulakis, Antoniou and Rajter (2021) stated that a more holistic approach to career counseling needs to be employed as there are more unemployed individuals as a direct economic impact of the pandemic. Drosos et al., (2021) proposed a career counseling model that is multifaceted which encompasses individual, group, and career training. The old career counseling model would focus on at least one of types of counseling service, however a more holistic approach is needed as clients need different types of support to help them find a new occupation as soon as possible.

Limitations and Recommendations
While this conceptual paper managed to source different research articles on counseling and COVID-19, the authors could not find any research articles from Malaysia. Therefore, it is recommended that future research focus more on the COVID-19 effects and implications on the counseling profession from a Malaysian context. This will help to enrich the counseling profession in Malaysia.

Conclusion
The worldwide population is still recovering from the devastating effect of COVID-19. Therefore, it is imperative that we are aware of the mental health effect of COVID-19 to the counseling profession. It is important that the implications for practice be heeded so that the treatment given are relevant to the issues being faced by clients especially if it is related to COVID-19. Individualized treatment based on COVID-19 mental health issues must be applied, so counselors in Malaysia are advised to improve their current knowledge and skills levels related to anxiety, stress and depression. Counselors should also apply creative methods in doing counseling as traditional face-to-face counseling cannot be done during this period. With COVID-19 cases still high in Malaysia, it is hoped that online counseling be practiced more, and that the Board of Counselors Malaysia encourage its practice to make counseling more accessible.