During the current health crisis, the greatest psychological challenge facing our clients is that of the fears triggered by uncertainty. Uncertainty about how many of us will remain healthy, how long the limitations on our lives will last, what the full scope of the economic implications will be, how we will feel safe again even after we have been told the danger has passed. As counselors living this same reality, it can be challenging not to feel consumed by this uncertainty ourselves, making it even harder to help our clients.
Something that we tend to forget in a time like this is that uncertainty is always present in our lives. None of us know the exact number of our days, what our jobs might look like in a year, or even what tomorrow will bring. But currently, with the advent of Covid-19, this uncertainty feels much more tenuous than usual. We are constantly reminded of our fragility as humans.
We have an innate desire to feel in control of our environment. This makes sense – security goes hand in hand with many of the elements critical to our survival, such as securing shelter, food, clean water, clothing; having a community around us and sustaining loving relationships. It is also our tendency therefore that when things start to feel out of control, fear can bloom within us.
So we certainly empathize with our clients’ fears here, as we may be experiencing similar ones. In sessions where we can start to feel overwhelmed by the fears, it can help to have a few techniques at our disposal to help clients in reducing their distress. I will highlight a few here that I think can be particularly useful.
Identifying Areas of Control
In understanding that the root of fear is the feeling of being out of control, it can be useful to help clients identify what they are in control of in their lives and have a plan for how they will focus on this. For example, help them to see that just by coming to counseling they have already taken steps towards taking control of their psychological coping. This can be an opportunity to bring into perspective other things that they may already be doing to take control of their coping. There may be positive measures that they taken to protect their families, or ways that they are making a successful transition to working remotely, or new activities to engage with their children. If we can find a way to shift our focus onto the things that we are doing, we may begin to realize that there are a lot of small ways we can begin to control our current circumstances. The balance to this though, is to not seek ways to over control what we cannot control. And in fact, when we do this, we often create greater anxiety for ourselves.
Diffusing Catastrophic Thinking
Worry in small amounts can have a positive function of helping us arrive at solutions we otherwise might not have thought of, so we can first of all validate for our clients that through worrying, they may have conscientiously arrived at some important ways to manage their individual situation. However, as we know from all other times in life, it can also spiral into a form of catastrophic thinking that is much less helpful. In spending too much time reading the news or statistics, it is easy to get caught up in worst case scenarios. In fact, research recently published in the New York Times, conducted by Ellen Peters and Par Bjalkebring*, indicates that those who spent time each day online stalking Coronavirus statistics were also significantly more anxious than those who did not. Peters pointed out that while it is important to stay informed of changes in guidelines or recommendations from the authorities, spending more time reading the news about the outbreak correlates strongly with increases in anxiety and a belief that one will contract the illness.
In dealing with catastrophic thinking, if you think it can be helpful to the client, have them work through what their greatest fears are about the situation, and how likely those are, and what they would do if those arose. You can then work with them on committing to the idea that they have now worked through these worries and do not need to keep returning to them. You can use a mental anchoring strategy for this. For some clients though, examining their worst fears at this time, even in a therapeutic situation, will only serve to increase their anxiety, so it is important to use your best judgment in who would benefit from this approach.
For other clients, I find it can be useful have them go through a strategy of how to best protect themselves and their families, and what they will do in case of emergency, perhaps even writing these plans down somewhere, and then work on reassuring themselves that they have done what they can to prepare and that they will not gain anything from continuing to repeat worry cycles about possible eventualities.
This tool can be helpful to use commit to not rethinking worries and fears that were dealt with in the previous section. With mental anchoring we work with clients to set up a phrase or image that they will call to mind when catastrophic thinking or repeated worries begin to come up. An example phrase could be, “I’ve prepared myself as best I can, now I need to move on,” and work on focusing their attention on something else. Or a mental anchor in a question form could be “If I weren’t thinking about Covid-19 right now, what would I be thinking about?” and then get engaged with whatever that would be, whether it is work, playing with their children, or talking to a friend on the phone. An image could be simply one of a path that has been blocked by a wall or other barrier. In developing this technique, we can of course empathize with our clients that like all forms of changing our mental narrative, this may not work right away, but it through committing to using it over time we are able to strengthen its usefulness.
Maximizing the Hopeful Moments
A great way of mobilizing internal client resources is to recommend that in a moment of feeling encouraged, clients write a letter to themselves to read when feeling discouraged or afraid. What would they want the frightened part of themselves to be able to keep in mind? Recommend that they read over this again in a moment when they need it.
Drawing on Client Strengths
Another way of contacting the internal resources clients already have is to help them get in touch with memories that they have of time where they got through a frightening situation. These could be a whole host of things, like surviving an accident, giving birth to a child, moving to a new place, losing a job, or others. This can help them to see that instead of seeking security in certainty about the future, they can focus on the knowledge that overall our certainty lies not in anything external but in our own abilities to cope with each challenge that may arise.
It goes without saying in this exercise (but I’ll mention it anyway just in case) to not use a life event that currently feels traumatic, but rather one where they could agree with you that they got through it well.
Important to Note in Using These with Clients
The way these strategies are presented is critical to how helpful they will be. We need to explain that these strategies of course do not resolve the current situation, nor is it our intention as counselors in suggesting them that we are trying to discount client fears. Instead it is our intention to help lower our clients distress, and we can explain this to them. Fear can cause paralysis and panic, neither of which are going to be helpful to our clients in taking care of themselves and their families, so the objective in using such strategies is to mobilize coping.
Fear at an Emotional Level
There is also a point at which stress crosses into fear. From everything we know about fear, it does not always respond well to reason. It resides in the emotional part of the brain and so there can be times that in order to reach it, we must address on the emotional level. My next post will go further into how we can use our empathy as counselors to assuage fear, but without encouraging it to grow.
It is also important to keep in mind that the uncertainty of the present moment can trigger underlying trauma or symptomology such as agoraphobia or obsessive compulsive disorder. These deeper issues may not respond well to some of the strategies listed here but may require a greater degree of emotional processing and support. I will go into this further in future posts, especially those on addressing fear at the emotional level and practice management.
As always it is so important for us as therapists to stay connected with our own sense of hope and purpose: that we bring light to others during a painful moment in human history. Even on days when we ourselves feel tired or overwhelmed we can remain hopeful that if we are able to keep going, others will be able to as well, and once again it is through our interdependence that we will be able to go forward.
Peters, E. (2020, March 12). Is Obsessing over Daily Coronavirus Statistics Counterproductive? New York Times.
Christine Forte is a counselor working in private practice online with the globally mobile community. She has recently repatriated to the US with her family after ten years of living and working in Shanghai, China. You can contact her at Christine(at)forteklotz.com or read more about her practice at www.forteklotz.com