The Cumulative Changes of COVID-19: A Therapist’s Perspective on a Dual Reality

Erin Watson is a Licensed Clinical Social Worker practicing in rural west-central Illinois. She has been asked to write about her own experience and challenges faced with the COVID-19 pandemic and what it’s like being a therapist during this unprecedented time.  

According to Pew researchers, approximately 90% of American adults have indicated that their lives have changed in some way, since the COVID-19 pandemic crossed over our nation’s borders. These changes range from not being able to go to dinner with friends or having to work from home, to the loss of employment and health insurance. The sheltering-in-place orders have no doubt accounted for the majority of these changes, and for some states, there isn’t a clear end in sight.

What has been your own experience, or general perspective regarding Illinois’ shelter-in-place order? 

As a therapist, I have been continuing to help support my clients and their families the best I can via teletherapy. Within the first couple of weeks of our shelter-in-place order, a client and friendly acquaintance reached out to ask me how I was doing, and I found myself initially trying to express the “I’m fine, it’s fine” sentiment. Which is such utter nonsense. But, I have been so focused on holding space for everyone else, that I was not at all prepared to answer the question posed to me. Sure, I have engaged in my fair share (and then some, probably) of unsolicited complaining to friends and family, but I haven’t really sat with my feelings with any intention because no one ever asked me to (and how interesting that I won’t just do this for myself). As I carried this in my mind, another couple of weeks went by and I found myself saying over and over again, “What a weird time we’re all having.” The beginning of every progress note I wrote, for 3 solid weeks, was exactly the same, “client discussed and processed experiences and life changes surrounding the COVID-19 pandemic”. Like we were in our own strange version of Groundhog’s Day.

Time continuing to march on as we were all feeling paralyzed, was like a swift punch to the gut. Being as transparent and as honest as possible with clients is imperative at any stage of the therapeutic relationship and process, in general, but seemed especially important now. Self-disclosure can be an effective therapeutic approach, but one that needs utilized with the utmost caution. Reasons for a therapist to self-disclose can range from normalizing an experience or providing an anecdotal example, to early rapport building or making known strengths and/or weaknesses of the therapist’s approach (i.e. not specializing in eating disorders). Whatever the reason, the disclosure should take place to help support the client vs. meeting a need for the therapist. The relationship should not become altered in a way that the information shared with the client, now causes the client to worry about his/her therapist. But what about when it comes to the COVID-19 pandemic?

We’re all experiencing the same trauma. All of us. Unless someone is literally living under a rock, watching; reading about; or hearing that our fellow citizens are growing ill and dying by the tens of thousands each week, is going to adversely affect most. This is a first for the majority of Americans. Additionally, we are collectively grieving some type of loss; a job, health insurance, going to school, or spending time with friends/family. But the bigger loss here is the loss of control. We’ve quickly been faced with the fact that having the level of control we believed we had over our lives, was really just a fallacy. And, boy, what a reality check. Plodding along this path, as a therapist, feels strange. Proceeding with sessions as I normally would helping my clients reflect; demonstrating empathy; and continuing to possess an unwavering sense of self-insight, seems disingenuous right now.

My life has also changed drastically. I am also facing new and evolving challenges. Quite frankly, presenting myself as if I still have all my sh*t together feels condescending to me. I give my clients all of the credit for their efforts, their accomplishments, and for their progress. Why wouldn’t I give them credit for thinking that I’m stressed or overwhelmed right now too? They’re intelligent intuitive people and I think its ok for them to hear some real and raw honesty from me. Plus, what a better time to be a good model and practice what I preach.

What were changes or challenges you faced?

The most immediate challenge I was faced with was as a business owner, and getting my practice positioned to do teletherapy. Despite the relaxation of HIPAA restrictions by the Office of Civil Rights and the Department of Health and Human Services, our professional ethical governing body as well as our various malpractice policy holders were coming forward saying, “not so fast”. I had to make sure that we continued to abide by all privacy laws as well as our ethical guidelines. In light of everything, though, the transition was a smooth one. Most of our clients have a well established relationship with their respective therapists, but engaging in a session over video vs. in person, is very different. Reading non-verbal cues is considerably more difficult for the therapist, not to mention how distracting it is to also see yourself the whole time. Our office also sees a significant number of young children and this particular modality poses many challenges. Technologically speaking, spotty connectivity can cause awkward delays, mismatched audio paired with the video, or complete failures. The biggest change I noted for myself was how fatiguing I found video sessions to be. I am also still facing some of the most challenging changes which is how the business side of things have been negatively impacted.

What do you think is most helpful to your clients right now?

Right now, we have a significant number of clients who have not been able to transition to teletherapy. Making sure we maintain a balance of reaching out for check-ins or quick support, but are not leaving them feeling pressured to engage in a teletherapy session, if their circumstances are a barrier, has been met with positive feedback. We certainly don’t want to add an additional layer of stress to what they’re already facing, but we want them to know we are still holding space for them and are here for them. For clients who are able to engage in teletherapy and are feeling a sense of loneliness and disconnect, helping them brainstorm creative ways to continue to connect with others has been a challenging but rewarding exercise. Traditional behavioral activation tasks like getting out to meet a friend for coffee, signing up for an art class, or joining a local organization aren’t options currently. Finding virtual alternatives has proved very valuable to our clients.

What are you doing for yourself for your own mental and emotional health?

One major thing I am doing for myself is following the recommendations that I share with clients. I am shifting my focus to what I can control and I can currently control if I am maintaining the semblance of a routine, how much physical activity I get, what tasks I want to get accomplished, and how I am spending my free time each day. I have had more free time in the last 4 weeks than I have in the last 4 years, so this has been difficult to navigate. I also allow myself some grace and compassion when I don’t get anything accomplished. There’s no correct way to manage what we’re faced with right now, so if I’m implementing and engaged in anything remotely healthy and positive, I’m feeling good about it!

How I am staying informed has changed. There’s so much information coming at us from our preferred news sources, social media platforms, and friends/family. Not all of it lines up or is consistent. This type of situation is ripe for misinformation and feeling confused. Something I began doing very early on was tuning all of that out. Instead of leaving the news on as a constant source of background noise throughout the day, I wait until I’ve had my first cup of coffee before I turn it on. I will only watch it for an hour at most, in the morning, and this is the only news that I listen to. I will then do an evening check-in through reading articles that I feel either most pertain to my business or is important for me to know, personally.

Keeping my personal appointments like my yearly wellness visit with my primary care doc as well as my own therapist (virtual, of course) felt important. Processing my own experience is kind of surreal right now. Back in February, I sought support for burnout. This was not how I envisioned transitioning to working less, but here it is, forced upon me. There is much to learn here, so I am making sure my feelings and experience of burnout juxtaposed with having what feels like endless free time, is not lost on me. Plus, every good therapist needs a good therapist, right? There’s something to be said about the timing of things.

Feeling gratitude towards the onset of our shelter-in-place order taking place just as spring arrived has been an important mental exercise. Getting outside as much as possible has been so very wonderful. I am thankful that I can take advantage of living in a rural setting with an abundance of outdoor space. I have also started to accept all of the emotions I am feeling rather than pushing back against the negative, energy zapping ones. Engaging in this exercise outdoors, on a walk or run, has been very positive.

There are many, but what is one take away from all of the challenges and changes you’ve faced?

Time doesn’t stop, and we’ve made it 4 weeks so far. 4 weeks! Week #1 felt awful and seemed to prompt the same question over and over, which was focused on how I was going to make it through what seemed like the most challenging series of events of my 17 year career. That first week seems so long ago already, and the adjustment to my new schedule and new routine feels…well…normal. I miss my clients terribly. I miss my employees terribly. I love our office and I miss regularly working within its confines terribly. But if we can thrust ourselves through the most difficult part of this change; come out the other side with our well-being in tact; and re-prioritize what is truly important to each of us, we have all the evidence we need to support that we can do anything. We are amazing creatures and what better time to test and trust our ability to cope than with these very trying times.