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“Unprecedented. Strange. Difficult. Uncertain. A test for humanity. The ultimate challenge of slowing down.” These are all words and phrases that I have used in recent sessions with clients to describe the present. Families, friends, and co-workers are socially distanced and staying home. Jobs and daily tasks are being categorized as essential and non-essential. News headlines contain words such as “quarantine,” “death toll,” “virus,” or “global pandemic” on a regular basis. Toilet paper has become our country’s most coveted item.
It is A LOT to cope with. And for mental health and substance use therapists trying to support people in this coping, the logistical hurdles of transitioning to telehealth (e.g., lighting, sound, WiFi signal, etc.) often pale in comparison to the clinical challenges we encounter. In the following paragraphs, my hope is to offer insight and support for therapists continuing care amidst COVID-19.
The first step in helping our clients navigate how the COVID-19 is changing their views of the world and of themselves is to acknowledge how it may be changing you as a clinician. While we are the ones seated in the therapist chair, we are also human and not exempt from feeling impacted by our environment. Over the last month, I have become less concerned about being the perfect provider with flawless technological systems; rather, I’m becoming more comfortable in showing my own humanity, which in turn, has validated my clients’ experiences and strengthened rapport. I have gained resilience in sharing my vulnerability. And in order to maintain this, I am practicing what I preach more than ever; helping clients take inventory of their coping strategies has pushed me to improve my own self-care.
These changes didn’t start occurring until halfway through week 2 of solely offering telehealth, and came about thanks to consultation with colleagues, engaging my personal therapeutic process, and good journalism. With limiting my consumption of social media, I was fortunate to come across the article That Discomfort You’re Feeling is Grief from the Harvard Business Review. While the title is direct and to the point, the author, Scott Berinato, lays out a Q&A format with the “world's foremost expert on grief,” David Kessler. In order to have a meaningful discussion about change, it can be necessary to attend to your clients’ thoughts and/or feelings about loss. Grief is an incredibly complex emotion; so therapeutically speaking, this process will look and feel different depending upon your client’s personality and history of loss, as well as your theoretical orientation (e.g., cognitively-driven, emotionally-focused, behavioral-based, etc.). Regardless, I encourage you to at least broach grief/loss as a potential aspect of your client’s experience. To echo Kessler, “When you name it, you feel it and it moves through you. Emotions need motion. It’s important to acknowledge what we go through.”
When you search for inspiring quotes about change, there are plenty: Leo Tolstoy’s “True life is lived when tiny changes occur.” Mahatma Gandhi’s “Be the change that you wish to see in the world.” Maya Angelou’s “If you can’t change it, change your attitude.” Despite these offerings of wisdom, changing our thoughts, feelings, behaviors, boundaries, etc. is incredibly challenging. However, the fact your clients are seeking or already engaged in counseling means they are a step ahead. People who participate in mental health and/or substance use treatment are change-seekers. Your clients are spending time, money, energy (physical and emotional), as well routinely taking risk to be vulnerable, in hopes of changing some aspect of their life. Highlight your client as someone in search of change.
For emphasis, I will write it again... Changing our thoughts, feelings, behaviors, boundaries, etc. can be incredibly challenging. In my career as a professional therapist, I have come to truly appreciate humans as complex, fascinating creatures. In order to be open and/or ready for change(s) in life, we must experience some level of discomfort. Living through a global pandemic is unsettling and uncertain. Frame the discomfort of the COVID-19 as a therapeutic opportunity. Invite your client to harness this discomfort to promote positive life change. Inspire and encourage your client to explore possibilities of new living, thinking, feeling, behaving, communicating.
A final encouragement for therapists is to record your client’s desired changes. Similar to treatment planning, this list can help solidify your client’s vision of who they want to be in the future and offer accountability for how they plan to interact with a post-stay-at-home world.