Being a Therapist During COVID

 
Being a psychotherapist during this period of the Covid pandemic – and especially during this current UK national lockdown – has required of me a level engagement with human suffering I have never known before. The field in which I practice – oncology and palliative care – has always been emotionally challenging, and this challenge I have embraced like a vocational calling. But the level of existential suffering present right now in the world, is quite unique. It has the flavour of hopelessness and resignation for many, now. It is requiring us to both face a dangerous, invisible and tricky opponent (Covid) and experience a level of state control we have never lived through before. This is a very different experience of life for westerners who have never faced the likes of Ebola or Small Pox. The experiences of lockdown and national alertness over the past year have been unprecedented, especially with this second national lockdown. The physical absence of sons, daughters; grandchildren, friends, lovers, and close others and hearing stories of grief and loss, of people dying alone, and the sharp rise of infections and deaths, are gargantuan for our humanity to bear.  
 
Counsellors and psychotherapists often allow themselves to be open to a process called relational depth in their practice. Relational depth is a way of being, not a method, gimmick or strategy. It is described in clarity by Mick Cooper, who is an author and academic in the field of counselling and psychotherapy studies, in his book Working at Relational Depth in Counselling and Psychotherapy. It is a profound allowing of connection between therapist and client. This connection, created by both client and therapist, enables a space in which psychological healing can take place. The therapist and client allow access to something that is both shared and profound; our humanity. It not only changes the client, but the therapist too. The potential for human connection and attachment are gifts we all possess. It enables us to extend and experience holding, understanding, solidarity, warmth, caring, safety, presence and hope. It requires courage to experience our own and the others vulnerability in a moment of human encounter. Vulnerability guru, Brene’ Brown describes vulnerability as our willingness to experience uncertainty, risk and emotional exposure. It offers a hand to the other sitting in the darkness of the proverbial Plato’s cave, to step out into the brightness of the day and to connect with others and the flow of life. Practicing relational depth in psychotherapy now, is a call to vulnerability and courage to meet suffering in a way we have never had to do before. 
 
Vulnerability, empathy and compassion during a time such as what we are living through now are gifts and graces.  However, for the therapist who opens their heart to such depth, they are costly gift to offer, too. I would say to other therapists and people working in helping professions, who are struggling with the weight of the times right now, to become a truly compassionate and loving friend to yourselves. I have really had to learn this over the past few weeks. Allow others who love and care for you to extend their presence to you. Do what is necessary to make sure you are grounded and nurtured. These are difficult times. Don’t underestimate the potential for burnout and energy loss. They are more real now than they have ever been.  

Compassion-focused therapy (CFT). How its wisdom might help us during times of COVID 19

During times of crisis or significant life challenges we are often trying to cope under the strain of events that are beyond our control. 2020 has been one of those years with the global pandemic of COVID -19.

For many of us, the national and local lockdowns and their impact on our lives (such as job insecurity, seperation from family members, loss of routines, the need to multitask employment and parenting all at home, avoiding the virus, isolation as a result of in sheilding in order to care for physically vulnerable family members and other problems) have often created feelings of uncertainty, loss of direction, despondency and frustration. We may have experienced symptoms of anxiety, fatigue and overwhelm. In managing our emotional wellbeing it can be very useful to understand how our brains and minds work. The core insights of a therapy called Compassion Focused Therapy offers us insight into understanding how our brains, thoughts and emotions operate.

At the end of this blog there is an audio recording to download, which will help you to undertake a calming activity called Soothing Rhythm Breathing (SRB). SRB can help you to enhance states of mental and emotional calm and thus attain better self-regulation.

What is Compassion Focused Therapy?

Compassion Focused Therapy (CFT) is a psychotherapy developed by psychologist, Professor Paul Gilbert. It is designed to help people cope better when they struggle with complex and difficult feelings and emotions. Right now, many of us are experiencing emotional difficulty. Living with illness of being the person caring for a loved one with illness can bring stress and difficult emotional responses.  

Compassion Focused Therapy (CFT) aims to enhance our capacities for caring and warmth towards ourselves and others, in order to promote feelings of safety and wellbeing in a world that can seem at times to be overwhelming.

What is compassion? 

Compassion is the capacity to identify suffering in ourselves and others and to do something to alleviate it. Compassion is composed of qualities such as caring, warmth, courage, wisdom, strength, patience and many others. With these qualities we can help to reduce harsh self-criticism, and to better evaluate what’s going on in our own and in other people’s minds. 

The minds of others 

Shame and self-criticism can make our relationships with others painful. The thought of being held negatively in the mind of another/others can enhance feelings of shame, anger and frustration. This is because our self-identity arises from our relationships with others. When living in close quarters with family or close others in a time of crisis, this can be a real challenge.

The theories that inform CFT, include social psychology, developmental and attachment psychology, cognitive behavioural psychology, evolutionary biology, and Buddhist psychology.  CFT describes the mind as being tricky because evolution has given us brains which can confuse and frustrate us when we are under stress.

Evolutionary biology

The human brain has been formed over millions of years of evolution to respond to various external survival life challenges. Gilbert identifies three systems in the brain formed by human evolution:

These three systems are necessary for emotional self-regulation. When they are in healthy balance, these systems keep us safe, calm and focused on thriving. However, when we become prone to self-critical, shame-based thinking and emotions, the threat system can enhance feelings of distress and anxiety, and cause depression and other psychological difficulties. 

Threat and Protection system. 

This system aims to keep us alive and safe from threats. It can create in us, strong emotions such as anxiety (fear or stress) anger (with self, others and life) or disgust (overwhelmed by revulsion towards something) in response to potentially threatening stimuli. It triggers the Fight; Flight, Freeze or Submission responses. These four responses are closely linked to the production of the hormone, cortisol which activates our stress responses (racing heart, panic, anger, rapid and ruminative thinking, etc.)

Drive System 

The drive system propels us to succeed in activities by honing our attention and focus onto life goals and positive projects. It mobilises our minds to function for success and attainment. For example, the drive system can be activated for preparing for a job interview, an exam, running a marathon and many other life goals. It is linked to a neuro-chemical called dopamine which is a brain based reward chemical. Trying to get through a period of challenge or crisis can activate our drive system too, in order to try and help us to get things done that are urgent or necessary (e.g., if you are a patient, getting through treatment and helping others worried about you, or if you are a carer, getting through supporting the person who is unwell as well as helping struggling other family members)
 

Soothing/affiliative system:

The soothing system brings about a peaceful state of calm and safety. When mammals have no immediate threat and have sufficient resources, they enter a state of soothing and restfulness. In terms of evolution the soothing system was also a key system for mammals to form close, affiliative and supportive attachments between infants and protectors/carers. It helps us to feel calm, relaxed and a sense of wellbeing. Caring and soothing behaviour is reinforced by the production of the feel-good hormone, oxytocin. 

The approach of Compassion Focused Therapy (CFT) is to help us to better regulate our emotional world through learning to calm down our brain and nervous system. It teaches calming and grounding strategies informed by Polyvagal Theory, a scientific model of intervention focused upon calming both our nervous system and our bodies. When we are able to create the conditions of calm and groundedness we are better placed to cultivate a state of compassion towards ourselves and others in order to bring about important changes ustilising strengths fortified by the the qualities compassion. These compassionate qualities include wisdom, strength, courage, warmth, care and groundedness. Compassion Focused Therapy aims to help a person to cultivate a resilient compassionate mind, or compassionate self that can navigate life and the world with greater strength and peace. Other interventions used would include:

  • Compassionate thinking,  
  • Compassionate reasoning,  
  • Compassionate imagery,  
  • Compassionate self-reflection 
  • Compassionate role play  
  • (And other methods).

Here is a recorded Compassion Focused Therapy exercise: soothing rhythm breathing. You might find it helpful to manage your levels of anxiety and distress https://drive.google.com/file/d/1h5nSEdoIvmSpl-zfaaV_U8NqdAQH-YEE/view

Helpful tips for staying grounded

Acknowledge kindly your feelings of distress and shame. This is important, especially in the context of our relationships with others. 

Recognise that your overwhelming thoughts, feelings, self-criticism and shame are not your fault. We have tricky minds which sometimes overwhelm us.

Be open to the care and support of trusted others with whom you have a close and safe attachment
 

Gently respond to your thoughts and feelings of distress with warmth, kindness, gentleness and calm. 
 

Validate your feelings of distress. 
 

Acknowledge that this is a very difficult time. 
 

Make time for soothing activities e.g., warm baths, soothing scents, soothing music, quiet time for breathing (use the MP3), etc.

Be kind to your struggling self; tell yourself that kindness, warmth and care are especially important for you right now. 
 

Forgive yourself for mistakes. You are human. You are precious. You are important.