Reflections in practice : Being shaped and reshaped in response to Covid-19

“Nautilus” image of Iceland in winter By Erez Marom (2015)

Reflections in practice: Being shaped and reshaped in response to Covid-19

By Michele Hayes, Psychotherapist and Supervisor

Caught on the prevailing winds of the pandemic I notice a strange inability to integrate my experiences.  Talking to colleagues I hear that they are feeling this too.  Together we have spoken of exhaustion. It comes not from physical exertion but the psychological and emotional energy required to navigate this terrain for ourselves and when walking alongside our community of clients.

In our professional capacity as therapists, we are familiar with and skilled in fielding difficult material and processes. We know how to bracket; sit with uncertainty and unknowns; reflect on the complexities of life experiences and to co-create, with clients, a spaciousness that supports potential growth.  My sense is that whilst it remains our goal to stay as present as possible in the therapeutic space, it has become more challenging given the strong headwind that is Covid-19.

Reflecting on my own process and that of colleagues who have shared theirs, there seems to be a split in our inner worlds.  One moment we are in a place of pragmatism and stoicism and then in a place of overwhelm; we are either in crusader mode or feeling impotent. We oscillate between different extremes, struggling to integrate the splits and hold both ends of this spectrum.  We are fully in one state or another. It is as if we are in collective grief and finding it difficult to stand on its undulating ground.

In our outer worlds, in relation to clients, many therapists have found themselves working exclusively online or over the phone.  This has been a new move for those who prefer to work in the physical presence of and face to face with their clients. Technology has been a saviour in maintaining vital access to mental health support and enables us to exercise our passion for the work. It has also exacerbated the concerns of some.  There are technical issues to deal with, often in isolation if therapists are in private practice.  Learning new skills can confront us. Broadband reliability and internet connectivity within the home, at either end of the conversation, can challenge the flow of a session. Feeling distanced from clients and having restricted access to the usual level, range and quality of ‘the felt sense’ experience can also add to a mix of challenges.

Connecting to clients via online platforms can feel more distancing on one level and yet sessions can also feel increasingly intense given the focus of the gaze on the screen.  I have been reflecting on what I had taken for granted; the natural ebb and flow of the relational dance when in the same room as my clients.  I had never considered it in this way before. It is new learning for me. I have now become more mindful of how I space my online appointments, allowing enough downtime and distance before re-engaging.

The intimacy of the therapeutic relationship has taken on another dimension as we find ourselves working with clients sitting in their own homes and they can see us working in ours (I have met a lot of pets recently). Being conscious of this, respecting and honouring the new spaces we find ourselves working from and in, feels important.  We are no longer in control of the boundaries of this intimacy in the way we used to be.  Shutting the therapy room door and having an uninterrupted session is not our sole responsibility any more.  I have had clients answer their front doors, have had family members accidentally walk in and those who have settled down with a coffee and a snack.  I think this raises a number of issues for me in the work with clients.  How do we come into relationship with the added uncertainties that these environmental conditions raise? How do we maintain therapeutic boundaries and safety? What do these conditions reflect our client’s way of managing boundaries in their world?

For those who usually see clients face to face, we are experiencing an external split world layered on top of the personal inner splits that we are holding.  No longer are we in the same physical world as our clients, sitting in the same room and therapeutic nest. We are in our physical worlds and they in theirs. This provides a powerful parallel, in the microcosm of our sessions, to the separation of our clients from their wider communities and networks.  Whilst it is a rich vein to explore in the therapeutic space I sense that this adds to the energy demand on our personal resources as therapists. How do we co-create the depth and intimacy of an I-Thou relationship through the I-It of a screen and technology?

Clearly there is a lot going on in the therapeutic frame, given the wider realm of environmental conditions, and mental health professionals are not immune to feeling impacted. In the same way, as our clients require more support I believe it is important for therapists to increase their personal and work-related resources at this point in time.  We also need to be mindful of changes in our working practice that may need to be renegotiated with our clients.

Sourcing support to help integrate the personal process of therapists in a way that resources their work with clients.   

This is a period of time when many therapists could consider upping the frequency of their supervision.  I realise that the pandemic has had an impact on the job security and financial stability of many of our clients, and in turn, therapists have also been impacted.  Having additional supervision could feel counterintuitive economically but an imperative for the longer -term professional wellbeing of practitioners and their work with clients. More experienced clinicians may find connecting for extra peer group sessions useful in this capacity.  Others may benefit from joining group supervision sessions where the costs can be shared between members.  Supporting ourselves helps us retain spaciousness and creativity in our work with clients.  We must not ignore our own mental health and the need for connectivity given the work that we do. The benefits of working together and sharing resources as a community of therapists under the facilitative guidance of supervision cannot be emphasised enough.

Being mindful of self- care at this time feels imperative.  Take time out to enjoy new or more familiar activities in a nourishing way.  It is still important to remain in line with government restrictions. Remember we are taking these measures to safeguard our wider community and frontline healthcare workers.

Creating and maintaining supportive home environments are also important factors.  Given the new way of living, some of us may be managing more intense relationship dynamics with partners or families. How do we navigate these? Reflecting on our needs and those of other family members may help negotiate new relationship contracts. For those of us living alone, finding ways of being connected in ways that nourish us is also vital.  If we find ourselves isolating it should not have to mean that we are isolated.  What would we be saying to our clients about this that we could heed ourselves?

Re-contracting a mutual agreement through open conversations with our clients.

The pandemic has resulted in a rupture in the way many of us practice.  There is a need to review the therapeutic alliance and have a discussion about safety and boundaries. Have conversations with clients about how to best prepare for a session, how to manage the therapeutic hour and then how to prepare for exiting the session and the return to everyday life in their own homes.  Ending online sessions can feel like a sudden vanishing once we press the ‘end meeting’ button.  This might be unexpected to the uninitiated. You might consider sending your clients an information sheet that helps guide their thinking around this. You may allow some time in sessions to explore new ways of coming into the therapeutic space and more mindful ways of preparing for the online ending.

If clients agree that personal privacy within their home is difficult then review the temporary focus of the sessions together. It might mean that for now the sessions become about support and maintenance. You can return to more activating issues at a later date, including those brought into the light through their current experiences.

Finally, given the experience for some of the intense focus of the gaze whilst working online, you may want to consider the pace of sessions and spacing of appointments in your diary.  There are times when both the client and therapist need to gain distance in order to return to the relationship. Silence and quiet space on screen may have a different quality to it. Staying mindful of how both client and therapist might inadvertently fill space to ‘avoid the void’ could be useful information to explore in the therapeutic work.

I am open to new ways of working and hold the possibility of there being hidden gems in this experience. The work is, after all, in the work.  However, these are challenging times for all.  We will catch this wind and gain lift by spreading our wings and being open.  Let’s work together to support and resource each other as best we can. When it feels we have the capacity for little that is often when we need more.  To my community of fellow therapists, I say go well and keep safe.

WORKING TOGETHER (David Whyte)

We shape our self to fit this world
and by the world are shaped again.
The visible and the invisible working
together in common cause,
to produce the miraculous.
I am thinking of the way the intangible
air passed at speed round a shaped wing
easily holds our weight.
So may we, in this life trust
to those elements we have yet to see or imagine,
and look for the true shape of our own self, by forming it well to the great
intangibles about us.

If you like to share your thoughts with Michele about her blog, please email: michele@zoetix.com.au

You can visit Michele’s website: http://zoetix.com.au/