Coronavirus, connection and care
The coronavirus pandemic will be a levelling experience for mental health practitioners and their clients, probably only paralleled in times of war. Of course, the outbreak and all the measures that have been introduced to halt its spread will impact people in different ways. At the heart of the matter, though, here we all are, dealing with an unprecedented and life-changing situation.
As I’m sure is the case for many therapists, the past few weeks have seen my energy and concern flitting between the personal and the profession. Each day, it seems, fresh news and government guidelines have hit us, altering our lifestyles and personal freedoms in ways that would have seemed unthinkable as little as a month ago. N.B. Everyone will have their own understanding and personal experience of the notion of ‘freedom’. I would like to acknowledge that I’m writing and using the term from an admittedly privileged liberal Western perspective here. This will have called for difficult, but necessary, decisions to be made about how we carry out our work. Dealing with the practical, administrative and clinical challenges of closing down face-to-face practice and offering telephone or online alternatives is something many in our field will have had to tackle recently.
In addition to this we will also likely be wondering how the pandemic will impact on people’s mental health, perhaps bracing ourselves for a surge of new referrals over the coming weeks. Moving from the general to the more particular, I imagine we all also have clients we will have felt especially concerned for at this time, due to the impact we perceive coronavirus and its implications will have on their lives. This could be because of, for example, loss of income or job security, a pre-disposition to anxiety, or known difficulty when it comes to coping with isolation or change.
If ever there were a time for us to feel truly ‘in it’ with our clients, we are currently living through it. I’m curious as to how this reality will impact our practice. It is, of course, still early days. Overall, though, the potential to strengthen therapeutic bonds and to edify other types of supportive relationships is one thing about the pandemic about which I feel hopeful. Of course, no one can ever truly match another’s lived experience. However, whether we like it or not, as therapists supporting clients with anxieties and challenges relating to the outbreak, we’ll inevitably be dealing with very similar difficulties ourselves at the same time. This creates a prospective bridge of understanding between ourselves and our clients although it is, of course, one to be approached carefully.
The impact on us and our work
So, how to manage the impact of the pandemic in our work? For me, after the practicalities of how we actually ‘see’ or work with our clients whilst in lockdown have been addressed, self-care and self-disclosure feel like the next most important issues. Fundamentally this means looking after ourselves and ensuring our fitness to practice, and also considering how we share our own experience in the consulting room (or, for most of us now, across the ‘consulting screen’!). Rather than approach these topics with more strict guidelines and a regulation-focused mindset (which we’ll all be seeing plenty of elsewhere in life right now), I’d like to call for a softening in our attitudes towards ourselves and our fellow practitioners, and a thoughtful, but increased flexibility when it comes to therapeutic boundaries.
Self-care, sickness, holistic health and grief
To address self-care and fitness-to-practice first, by now we all know how vital it will be to avoid face-to-face contact with clients over the coming weeks, particularly if we feel so much as a flutter of ill-health, or if we believe we may have been in close proximity to anyone with the virus. We’ll probably be checking our own physical well-being scrupulously and monitoring for any symptoms that might indicate we have contracted Covid-19 and may be laid low, needing to cancel our appointments for a period of time. It’s not my intention in this short article to go into all the potential implications that being sick and cancelling sessions might have on one’s clinical work. Needless to say, though, this is a time to be making the most of supervision and considering the benefits of having a clinical will and chosen colleague to help contact your clients and manage your work should you fall seriously ill.
Amidst all the chaos and changes, though, even if we continue to feel fundamentally healthy, we must, of course, look beyond the physical and check-in on ourselves as to how we’re doing holistically. Absorbing and dealing with harsh new realities in our work and day-to-day lives means we’ll have likely seen familiar personal resources and resilience-boosting facets of our worlds stripped away recently. I, for one, felt this happen in several successive and savage blows the week before full lockdown kicked in, when I learned that the local art classes I attend to relax, socialise and channel my creativity, were being indefinitely postponed. Next, my yoga studio announced its closure and then, finally, the blanket ban on going to pubs, bars and restaurants was announced. On the strange new coronavirus timeline this feels like old news now. However, I remember clearly how unsettling it felt when, within a matter of days, a vast swathe of the things that usually keep me feeling balanced and happy were suddenly snatched from me, shrinking the parameters of my world.
In many respects I’m still smarting from these losses although, like most of the population, I’ve started to find ways of adjusting. Modern technology, of course, brings us a myriad of ways of keeping in touch and, with pretty much all the activities and opportunities that have been taken away from me, I’ve been able to find online or stay-at-home alternatives (or, interestingly, let a few things go!). Nonetheless, I’ve come to recognise that, with so many of my own precious freedoms lost or drastically curtailed, in a way I’m grieving, and grief needs to be honoured and allowed to run its course. I’m by no means the first therapist to liken the phenomena so many of us are experiencing in the wake of the pandemic to grief (Kessler, 2020). As a bereavement counsellor I spend a lot of time reminding clients that grief has the potential to be exhausting and unpredictable, and that trying to dodge or overcome these aspects of grieving is generally futile. Therefore, whilst it’s been great to recognise and savour some of the surprising ‘silver linings’ that lockdown has brought, such as the satisfactions of store-cupboard cooking, or the newfound opportunity to finish novels and watch old films, it’s also been important to yield to the tears, bad moods, tiredness and fear that have arisen as a consequence of reduced freedom and uncertainty. It might not be appropriate to show these parts of my personal process to clients during actual encounters with them. However, it feels like a duty in terms of my commitment to self-care as a practitioner to allow space in my life for those more difficult feelings to come to the surface and get worked through. Now is certainly not the time to aspire to ‘being brave’ in terms of being emotionally super-human.
A new attitude towards self-disclosure
From this tender new attention to self-care that I’m being called to make stems a new outlook on self-disclosure. Whilst living and working in a radically changed context might not, in itself, be reason to tear up the old rule book, former ways of working surely warrant rethinking now. If it’s evident – as it will be – that I’m facing some of the same kinds of challenges as my clients are, how virtuous or, indeed, helpful, is it for me to try to hide that from them? The tussle with authenticity that would ensue, were I to attempt this, is not something I would not want my clients to witness as I think it would appear awkward and alienating.
Of course, I’m not advocating a ‘free-for-all’ of uncontained and unthought-through personal sharing with clients - particularly at a time when so many other aspects of their lives may seem in freefall and the predictable boundaries of therapy therefore feel more necessary than ever. The ‘golden rule’ of self-disclosure is something I’d still hold as fundamental – i.e. asking the question as to whether any sharing is being done for one’s own benefit and catharsis, or for the benefit of the client and the strengthening of the therapeutic relationship. It should, of course, always be the latter. However, now’s a time when, as professionals, we can perhaps experiment with self-disclosure a little more, with a view to conveying something human and relatable to our clients at a time when this is sorely needed. If we’re cautious to hold back from sharing anything too deeply personal, such as the impact that illness and isolation may be having on our individual relationships or finances, then we are unlikely to reveal anything that will drastically ‘rock the therapeutic boat’ or prove controversial.
On the contrary, an openness to letting clients see that we’re also feeling the consequences of what’s going on is likely to feel normalising and relatable. In my experience over the past week or two, this hasn’t needed to be strategic or deliberate in any way within my practice – it’s usually felt quite light in touch and spontaneous. When clients have asked me how I’m doing, for example, I’ve been a little more honest than usual in indicating that there have been some ‘ups and downs’ for me over the preceding week. My reason? It may seem very strange if I suggested there hadn’t. When sharing resources or engaging in discussion about ways of coping with the practical and emotional challenges of lockdown I’ve also occasionally ventured into disclosing what has helped me. Reflecting on a session earlier today where a client and I were discussing home exercise routines I can report that this sometimes brings some much-needed levity and healing laughter into therapeutic exchanges!
It is, of course, far too soon at the end of March 2020 to comment on what the impact of coronavirus will be on people’s mental health and, indeed, on the working practices and attitudes of mental health professionals. Individuals within our world of work will be writing and thinking about this for many years to come and, fortunately, it seems, we will soon have access to carefully gathered quantitative data on the matter, for example The Guardian’s monthly poll to monitor mental health in the UK during the lockdown (2020), as well as our own qualitative observations.
As the situation changes and the impact unfolds, though, one thing we can all currently do is observe ourselves, honour our feelings and find ways of processing them. Supervision, collegial conversations, personal therapy, journaling, creativity, exercise and contact with loved ones are all ways in which this can be done. However, this list is by no means exhaustive and part of what we will be called to do is to find out what works best for us. Even if we’re not explicitly sharing what we’re going through and how we address it with our clients, this will hopefully lead to us meeting them in a healthier place. We will also be modelling something vital about self-care at one of recent history’s most important moments.
Felicity Runchman is a BACP-accredited counsellor working for several agencies and consultancies (including FD Consultants) and in private practice. She is trained and has a particular interest in text-based online counselling and providing other means of remote psychosocial support.
Berinato S. (2020). ‘That Discomfort You’re Feeling Is Grief’, Harvard Business Review [online]. March 23. Available at: https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief [Accessed: 31 March 2020]
Sample, I. (2020). ‘Monthly Poll Seeks To Gauge Mental Health Of UK Under Coronavirus’, The Guardian [online]. March 30. Available at: https://www.theguardian.com/society/2020/mar/29/monthly-poll-monitor-mental-health-uk-lockdown-coronavirus [Accessed: 31 March 2020]