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.
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.