I have the privilege of having a guest blog by my dear friend and colleague, Liz Sheean. In this piece of writing, she reminds us of some important points of how to respond to clients in therapy, in the times of COVID 19.
10 Thoughts for Responding to Distress and Fear in the Chaos and Complexity of Coronavirus
The coronavirus crisis is placing enormous pressure on health professions at the frontline in an environment described repeatedly as “unprecedented”. While some people will have an existing mental health issue, and others might develop significant mental health issues, we have to remember that most people eventually cope with traumatic events without developing a mental health condition. While acknowledging the complexity and chaos of this situation, here are some thoughts on how to keep things simple and sensible in a way that respects the personal responsibility of individuals, believes in their ability to cope, and reduces the load on the health professional. Take a breath and be aware of the many natural impulses you may experience that may not be helpful.
1. Basic counselling skills work best but take discipline to apply. The research tells us that the most effective strategy in responding to distressed or fearful people is to provide simple empathic responses that acknowledge emotions such as fear, worry, loneliness – without pathologising.
Good empathic responses can take the form of:
a) “It’s appropriate to be more worried than usual. These are crazy times.”
b) “I know this is really tough for you right now. I could come up with all kinds of suggestions like read a book, take a walk, do a jigsaw puzzle, but I would rather ask you what works for you when you have experienced difficult times before?” Sometimes you will be amazed at what people say.
c) “It is no surprise that you feel lonely at the moment. We know there will be a time when this crazy isolation will end, and I could suggest ways you can reach out to others but I am sure you have thought of these. I imagine you have felt lonely before in your life but these are very different times. What do you think will help you cope with the loneliness and make life just a little easier for yourself?” Again, sometimes you will be amazed at what people will say.
d) Or just “Geez, that sux!” or “This is just awful”.
2. This is not a time for “platitudes of gratitude”. Telling others to be grateful for the good things in our lives does not help when they are experiencing mortal fear for self and loved ones. And who says gratitude and fear are mutually exclusive? We can be grateful and fearful at the same time. And it is fine to have messages of “we are all in this together” in the media, but it may not help to say that to people who are distressed or afraid. People are “resilient” in all kinds of amazing ways but take care when using the term “resilience” with distressed/ fearful people. It may not be valuable at all when people are feeling like they will break rather than bounce.
3. Mindfulness has a place but is not a universal panacea. Try to avoid mindless murmurings of mindfulness/ meditation. These are useful practices in the right context, but are not appropriate first steps when people are distressed/ grieving. Have you noticed how you feel when someone tells you to “calm down” or suggests you “practice mindfulness” at difficult times? Mindfulness has a place when integrated with insight at more stable times in one’s life.
4. Over-empathising and compassion fatigue. Empathy is a finely-tuned and simple skill. When we over-empathise and feel the need to “fix” the pain of others we take on their burden and even rob them of their impulse to take responsibility for themselves. This is a sure path to compassion fatigue/ burnout.
5. Destructive entitlement. Compassion fatigue can lead to “destructive entitlement” – a state of being that develops because you have been so “good and kind and have taken on so much” at work that you expect others outside of work (especially those closest to you) to treat you with kid gloves and you may even find yourself lashing out.
6. Advice giving. There is always an impulse to give advice…but remember that often people are not asking for advice and don’t need advice. Again, they just want to be heard. If people ask for advice that is a different story – but take care to offer advice in a way that respects the individual’s ability to be resourceful for themselves.
7. Positivity and humour are great things but this is a time to take care. If you feel a compulsion to “cheer people up” or take on the role of the “positive thought police” be aware that people often don’t want to be cheered up, or told to be positive, or be offered forced and facile humour. They just want to be heard and have their feelings acknowledged. Use black humour with great care. It helps some of us through difficult times but is not for everyone.
8. Discomfort with the feelings of others and the impulse to pathologise. Be aware of when you might have discomfort with the feelings of others and want to shut them down or offer moral lectures. All kinds of feelings are normal during these times of stress, e.g., anger with others who don’t follow the physical distancing measures, existential feelings of sadness and “depression”. We will all feel the reality of this situation in many different ways.
9. The value of encouraging people to not be afraid of their feelings. In a world obsessed with happiness and positivity, it is worth reflecting on the writing of Robert Leahy (2018):
“Everyone is vulnerable to experience the full range of “problematic emotions,” including anger, anxiety, sadness, hopelessness, jealousy, envy, and resentment, but not everyone develops a psychiatric disorder¼ if the individual normalizes these emotions, is able to tolerate unpleasant and “conflicting” feelings¼ recognizes that these emotions are temporary and not dangerous, and is not ashamed of these feelings then it is unlikely that longer-lasting emotional problems will ensue.
In contrast, if the individual believes the opposite—that these emotions are abnormal, do not make sense, that one should feel only one way, that these feelings will last indefinitely and go out of control, or that they are shameful—then the individual may ruminate, isolate, avoid, misuse substances, and criticize herself.”
10. When confronting existential issues, sometimes there is nothing we can do. These times call for brave conversations. And sometimes it is best to say nothing and just sit with someone.
Liz Sheehan
Leahy, R.L. Introduction: Emotional Schemas and Emotional Schema Therapy. Journal of Cognitive Therapy, 12, 1–4 (2019). https://doi.org/10.1007/s41811-018-0038-5
