The Challenges of Working in the Current Context

Being present for clients remotely

Can remote therapy be the answer for our clients’ needs in this pandemic?

Navigating the unusual challenges of therapy in these strange times

It would be safe to say that in the current climate, everyone is stressed. If there is one thing we can say with any certainty about the current situation, it is that everyone is stressed. How that stress shows, for any (all) of us, is more individual, but the stress is everywhere. Where there (were)are conflicts and difficulties to deal with, this current situation has made everything worse for nearly everyone. Even the people for whom it is a relief to not be expected to manage the activities of everyday life and relationships, are still under a lot of mental and emotional pressure from what they can perceive about the world around them, which clearly feels mostly negative and depressing at this point.

So, what can we say about working clinically – remotely and in a pandemic?

Here a few thoughts. Working remotely has particular challenges. If you are working on the phone you only have the person’s voice to tune in to. We know people say so much more than words when they speak. If we just have the words, it’s doubly hard to hear the music behind them. If you are working with video as well, you have more information about the person; their expressions and their body language – from the shoulders upwards at least! But you also have information you otherwise would not have; you can see where they are, and you are in their space. Working in the consulting room together, it is the clinician’s job to safeguard the space, and we are all careful to pay attention to this part of the treatment. Working on video you have no agency about how the therapeutic space is protected. While this can present challenges, still, working remotely is usually infinitely better than nothing. Our clients need us more than ever during this difficult time, and even though providing therapy remotely may not seem ideal, it is a great deal preferable to leaving the clients much like unmoored ships in a storm.

Working in a pandemic, the patient’s/client’s right not to know about their clinician’s life situation and preoccupations is lost. The person is much less free just to concentrate of themselves. Their normal thoughts and fantasies about their counsellor/therapist are inevitably coloured by what they cannot avoid knowing – that we are all anxious and facing the same privations and problems in the outside world.

Another challenge is how to help people whose life experience before this was that the world is a dangerous place, and that people who are meant to look after you either can’t or won’t. They are facing a kind of PTSD; their earlier traumas are evoked by this one, and the many examples of denial, incompetence and callousness around it, that are regularly reported.

Plus, there’s a reason why the plot lines of horror films sometimes involve a silent, invisible, deadly enemy. It’s the stuff of primitive nightmares. It is very hard to find a safe internal place in these circumstances.

Finally, we are now facing questions about who has had the vaccine, who can get it and who has to wait. People are frightened and envious simultaneously. If they have not had the formative life experience of ‘fair shares for all’; the inherent unfairness of the whole pandemic and the vaccine allocations will produce more stress.Anxiety and envy will (may) be looming even larger than usual in the consulting room.

It is important to think about these things, to support each other in our work and to be able to work with the people who come to us for help. And it will be even more important in the future. This is in some way traumatising for everyone, and many more people will need what we can offer.

Jan McGregor Hepburn, 5^th Feb 2021