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Compassion in a Time of Coronavirus Crisis: How Therapists Can Help Clients Without Losing Themselves During the Pandemic

As I write this the world is in lockdown, held to existential, psycho-emotional and financial ransom by the Coronavirus Crisis. It would be abnormal for you not to be affected by what is happening, as no matter how aware or robust you are there are a myriad of ways in which you are being impacted. Polarised swings in emotions are common as you lose ground and find it again, you feel the flood of anxiety in your body but then enter a place of calm as your physiological state re-groups and re-calibrates to a secure normality, you catastrophise about possibilities but re-frame and find the mental overwhelm settles. How you deal with the incoming data cannot help but be associated with your everyday attitudinal patterns, behaviours, somatic and emotional responses to events. Your history, no matter how ‘worked-through’, analysed and de-cathected it is, will raise itself up from the shadows in times like these. You are not immune or protected because you are a therapist. Why? Because you are a human being experiencing a multi-faceted crisis.

The Coronavirus Crisis is something of a leveller within the therapeutic relationship. This shared trauma state is highly relevant if you are currently working with clients during the Coronavirus Crisis. Some of the re-assuring therapist/client boundaries are eroded. The “You, Not-Me” is not quite as distinct. The contents within the resonant empathic space are not quite as separate as normal and the traditional navigation tools used to discern “What’s mine and what’s yours?” might not be so efficacious as you occupy a shared “I am dealing with a crisis too” space.

What are some of the issues which are pertinent in the context of the Pandemic and how can you ensure that you are therapeutically functioning in an appropriate manner at this time?

Self-Awareness and Contamination of the Therapeutic Space

Firstly, be observant of yourself and what is arising in you to be dealt with as a consequence of this crisis. As you will know, trauma begets trauma. When new potentially traumatic events (or can we call them peri-traumatic?) infiltrate the psycho-emotional and psycho-biological systems they can activate prior imprinted and wounding experiences. What historical experiences are bubbling up to the surface for you as a consequence of the current crisis? Not the ‘you’ wearing your ‘therapist identity’ but the ‘you’ with the reduced income, the mortality concerns, the physical distancing from elderly loved ones. The ‘you’ who shakes your head at the toilet roll debacle who has to queue up at the supermarket to source basic supplies for your family. In these situations the repressed will return to be attended to and will be a veritable housemate for the current and legitimate stressors you are facing.

Whilst you may be familiar with taking your ‘whole’ self to your therapeutic work and using your prior healed experiences to affect positive shifts in your client’s presentations you need to be very measured about this right now. Without an observant and self-aware stance, that which is unconscious to you, that which is denied, numbed or dissociated, can interpenetrate your work and fill the already potentially flooded Venn diagram intersect between you and your client. Who is containing who? Do you have the space for holding all of this crisis material right now? Take a breath and think about it.

Wounded Healer Considerations

The wounded healer archetype is a strong activating force for many therapists at the moment. The need to rescue, to help, to save, to be in-service to a compassionate cause. This is an animating and potentially beneficent force for both you and your clients. A trajectory of momentum, the opposite of stagnancy and freeze. But there can be many issues with this – because for every rescuer there is likely a victim. There is also the possibility of shared and co-created ‘wounded healer enactments’ as cycles propel and reverse during sessions. Consider this. You believe you are being authentic and validating when you say “Yes, it’s hard for all of us right now”. See how ‘you’ and your wounds and your experiences of the crisis sneaked in there? Depending upon your client’s state of cognitive and emotional regulation at the time, they may hear this passive aggressively, dismissively or supportively. Depending upon context you may be imposing ‘hardness’ and victimhood on someone currently feeling robust and assertive. Perhaps even worse, you may be identifying yourself as having needs, as being needy, thereby reversing the relationship and triggering your client’s animation into ‘healer archetype territory’. Having established a formerly positive ‘holding environment’ you are now risking the frame and the possibly hard won secure base connectivity within the relational dyad.

Attachment Insecurity

These are insecure and triggering times. Clients will inevitably be seeking the foundational hallmarks of a secure attachment relationship including emotional stability via object usage, consistency, synchrony and safety. Ensure you are emotionally reliable when you enter your sessions and that you can attune to your clients needs without feeling compromised. If you need space for your own literal or processing needs it is important to take it and postpone or refer-on clients. Work with authenticity and confidence as during times of crisis clients often need a stronger and more explicitly direct holding environment. A re-assuring, trustworthy and safe “good breast” who exudes an authority which stabilizes. This is not a time for “blank slates” but for strong and unwavering attentiveness and support. “I’m here for you and with you!” “I get it!” Do what you need to in your own personal lives to hone that robustness, an inner strength and resilience for these times.

Vicarious Trauma and Self Care

Vicarious traumatic injury is a very real threat to therapists during the Coronavirus Crisis. Compassion fatigue is what it says on the box, feeling drained, burdened and overwhelmed as a consequence of offering a heart space and an empathically resonant self to others. This is a time where one of the key precursors to PTSD is strongly activated – empathic over identification with others. The psycho-emotional and psycho-biological responsiveness which contains and validates your clients in less compromised times can go into overdrive. You can not only feel into their space, but you can acknowledge a wide field of shared external and internal identifications. Both you and the client unable to see loved ones, dealing with the challenges of isolation, experiencing an intruding existential threat, and more. A transformational holding environment and synchrony which can affect the therapist’s sense of separateness. Before, during and after sessions. Re-integration, regulation, grounding and self- nurture are absolutely crucial during these times in order that the “good enough” reparative work is still available and accessible to your clients. Whilst parenting yourself keeps you stable and robust and overts against decompensation and fragmentation.

Have you thought about turning compassion back onto yourself? You can do both of course. To be there for yourself, as well as ‘showing up’ for your clients. White Tara, the Goddess of Compassion, holds one hand up, palm forward as if being protective and saying, “I have set a loving boundary for myself”. Whilst the other hand faces down, palm forward, as if to beckon those in need to step forth and receive. Be forthright about your own needs, your own external and internal momentum or closure around nurture. This is not only in your own interest but is a refrain from damaging your client.

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Seek and Destroy: Envy and It’s Modus Operandi

In my clinical experience envy rears its ugly head in everyday life more than it appears in the consulting room. It seems to be the case that expressing this shadowy part of the self is so wrapped in shame and the fear of negative judgement from an outsider witness that its expression is abandoned. In this act of abandonment it leaves material of crucial significance on the outer side of the consulting room door.

So why is envy so shameful, so unable to be expressed and acknowledged? Is it because it is so destructive in terms of the ‘other’, or because of its internal mechanics and the deep, hidden, vulnerable layers within the self which birth envious reactions in the first place? Let’s explore…

Karen was a businesswoman and was married to John. The marital couple were considered as physically attractive, professionally successful and had longevity in their relationship. Neither partner had strayed and fidelity was an established connector; as were their future paced goals. They were what one might call a ‘solid couple’. One evening they attended a business event and were introduced to a single woman, Anna, whom John took an interest in at a socially engaging level. Watching – that which on the surface looked like no more than a pleasant conversation with resonant aspects between her husband and the single female – Karen felt threatened. She was aware of a rising anxiety in her chest. Her head, her logic, held no sway here. This was emotional territory. The stimuli was the threat of loss, the effects bore emotional and physical content, the behavioural reaction was to act to protect against a perceived loss. Karen verbally instructed this third party intruder to sit in a specific seat at the table “Away from the men!” i.e. away from her husband.

Fear is a hallmark of envy. When fear strikes, when threats appear, they require to be mitigated against. In this case the strategy was to ‘remove’ and contain the threat. Once Anna was parcelled off, Karen’s emotions and body calmed as pertained to the perceived threat of Anna. However, the effects of the initial threat transformed into anger towards her husband accompanied by a heaviness in her tummy. With Anna at a distance across the dining table from ‘her man’, and an awareness that expressing this seething and primitive up-swelling of anger would not hold any rational legitimacy if recounted to her husband, Karen was able to sit somewhat pleasantly through dinner with the cohort of friends and colleagues around the large table.

However, once an energetic charge is created it must be released in some form, and in this scenario it was released in an almighty slap across her husband’s face; when after dinner and during the phase of social interaction, music and dancing, he Facebook Friended Anna in recognition of their shared links with Anna’s sister.

So why is this envy? Well, envy has a lot to do with perception and self judgement. It goes along the lines of, if I perceive such a threat in such a context, then I am judging myself to be under threat, and if I am judging myself to be under threat then in some way I have constructed a hierarchical assessment repleat with psychological and emotional content that the ‘other’ is higher, bigger, better, more attractive, and so on, than me. Henceforth, and in order for me to maintain equilibrium, they must be ‘reduced’ via a psychological process of destruction.

Of course there’s more to it than that. For a start there’s a historical component, a rhythmic dimension, in that it may be possible that intervention was determined as necessary because Karen held a perception, a belief system, that lest she not intervene (perhaps as she had felt called to do many times in the past?) then maybe, just maybe, this would be the occasion during which her unfounded fears became founded.

History also rears its head when we look at Karen’s perceptions of her self as this is the self that reacted to and acted upon the incoming stimuli. In this particular case Karen was a woman who felt professionally unfulfilled, a little overweight and therefore not as attractive as she would like. She was a woman who had invested time and energy into her marriage and her children often at the expense of herself and her own needs. With investments, risk becomes present and its attendant fear of loss. This in combination with her negative self judgements, in conjunction with the presentation of Anna – an object ‘believed’ to be higher in the hierarchy and risky on the investment index – brought forth a psychological necessity to “seek and destroy incoming threat”. Destruction of the threat is a core aspect inherent within envy.

I often laugh at the early example I heard during my psychotherapy training: A woman buys a gorgeous pair of shoes and shows them to her friend. Rather than validate the purchase and coo over the design and colour the friend asks rhetorically, “Did you buy them in the sale?” Bam! Seek and Destroy! Passive aggressive derision! The transformation of something which could be perceived as a non-event into a psychological event with a psychological necessity to make oneself whole by using destruction to mitigate the risk of being reduced to ‘less than your friend’ – all via an innocuous in itself pair of shoes. Never ask your friend “Does my bum look big in this?” And, especially not, if you actually look great! Trust me. You have become a threat.

In envious destruction there are two sides to the story, two players, the suddenly vulnerable destructor and the passively or explicitly attacked destructee. In this case, Anna was one of the victims of said destruction. When she was instructed to “Sit there away from the men!” her mind became preoccupied with self-judgment. She ran through the scenario in her mind and questioned what she did wrong, had she been overly friendly, had she overstepped some social boundaries and so on. Her vulnerabilities of attending the function alone peaked. Her self assuredness depleted and she consciously became hypervigilant about averting her gaze away from the couple. She struggled to engage in everyday conversation with the cohort of strangers around the table and physically noted anxiety in her body.

The time over dinner transmuted much of the tension and her emotions gradually morphed into self assertive mild indignancy and anger. Acting on this newly arrived space of self assuredness, and in the mix embracing resentment in action, she happily engaged in a few minutes of cursory social banter post the meal with John. During which time they found a commonality which they concretised by becoming Facebook Friends. At the point of the slap to John’s face she left the event feeling humiliated and rejected, and sad and angry that an identity had been projected towards her which bore no truth in reality.

Another victim in this scenario was John. He was shamed by the physical wound but fearing the wrath of his wife, and empathically acknowledging her plight, he held back from any expressions of distaste and made light of it. The abandoned shame of his wife had clearly been ‘split off’ and carried by her spouse. He ‘shut down’ and allowed himself in that moment to become something he inherently was not. Weak and ineffectual. A mirror to his wife’s sense of disempowerment when faced with the perceived risk of Anna. The ramifications of this would naturally play themselves out over time in the dynamics of this couples relationship.

Envy does not only destroy, it’s not only an aggressive survival mechanism. It turns reality into fantasy, it creates worlds that previously did not exist, it shifts identities, creates incongruence and incoherence within the self, and via projection lies and twists the truth within the ‘objects’ and the object relationships in our lives. Victims of envy must fly a banner emblazoned with the words “I am not that which you would have me believe I am”. Whilst the vulnerable perpetrators must acknowledge those shadowy and insecure parts within themselves which have been triggered in order to understand themselves more fully. Recognition of envious thoughts can thwart envious actions and such awareness can also catalyse development of those parts of the self which are open to doubt and deprecation, and negative self judgement.

By Paula Fenn (Transitional Space)

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