OPINION
What it's
been like to be a psychologist during the COVID pandemic
ABC Everyday Dr Ahona Guha
Source
During
video sessions, Dr. Ahona Guha has seen clients in pajamas and bathrobes and,
"on one memorable occasion, [one] drank a glass of wine at 10.30am".
The
nine years of university study I did to become a psychologist taught me many
things.
How to diagnose disorders, how to
understand a client's difficulties, how to form a rapport, and how to treat a
range of psychological issues.
They did not, however, teach me how
to be a psychologist in the middle of a pandemic during waves of rolling
lockdowns.
They did not teach me how to do
therapy wearing a mask for eight hours a day or when to breach public health
orders and allow a crying client to slide their soggy face mask off.
They did not teach me how to manage
the separation between work and home; when clients looked directly into my
home, and I into theirs.
This is what the pandemic has been
like for me as a psychologist.
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No more blank slate
A common precept in psychology is
the concept of being a "blank slate", and being neutral and somewhat
anonymous, to allow a client to bring what they wish into the room without
anticipating your reactions.
Working from home blew this out of
the water.
I was faced with odd difficulties,
such as trying to create a space for Zoom that looked welcoming but did not
reveal too much about my personal taste, attempting to make repurposed dining
chairs more comfortable for a seven-hour therapy day, and wrestling with the idea of whether it was professional to sometimes do therapy on my couch for a
break for my back.
My clients appeared to me in finer
detail and nuance than ever before. I have done therapy with clients in bed, in
cars, and on couches. I have seen clients in leggings, in rumpled pajamas, and in
their bathrobes.
Clients ate during our sessions and
on a few memorable occasions, clients drank a glass of wine at 10.30am.
I have been shown pets, plants,
gallery walls, introduced to partners, and new apartments.
The normal structures and boundaries
between clients and I came crashing down and I had several debates with myself
about whether to attempt to enforce normal boundaries with clients to provide
containment, or to allow people to do what they needed to do to cope.
I eventually settled on the latter,
reasoning that unexpected times necessitate unexpected coping mechanisms.
I also felt privileged to be allowed
into people's homes and found myself connecting with clients in a way that
working in an office would never have allowed.
It's all about COVID
Psychology practice would usually
involve working with clients with a range of difficulties and on any one day I
might see clients with depression and anxiety, a history of trauma,
difficulties with drug and alcohol use and trouble managing life stressors.
This pivoting is demanding but keeps
me engaged and nimble.
During the lockdown, all my sessions
have become about managing lockdown, regardless of what my clients had been
working on with me prior to the pandemic.
It has been exhausting, and I have
found myself running out of answers for clients. The usual things psychologists
would suggest for mood management were largely off the table for clients and my
suggestions of yoga, mindfulness or a nice walk after work have felt
ineffectual — like fiddling as Rome burnt.
Being OK, when everyone else is
not
I am often asked how I keep myself centered,
when my work involves sitting with people often at their lowest ebb in life.
The answer is equal parts training,
knowledge, supportive structures, general resilience and engagement with my own
life.
However, I realized during the
pandemic that a big part of keeping my spirits intact while dealing with the
bleak is recognizing the natural separation between the lives and difficulties
of my clients, and my own life.
In the last year and a half, this
separation has been lost.
I have shared most of the
difficulties my clients have had, including managing the isolation and
pragmatics of working from home, anxiety around press conferences, worry about
family overseas, sadness about plans being overturned, guilt about the sadness
in the face of our relative good fortune, loneliness, boredom, and burnout at
work without the solace of weekends and fun.
I have been forced to consider how I
can wake up and face each day and bring full attention and presence to each
client when the greyness of life and anxieties about lockdown they described so
closely resembled my own and when I found it so hard to focus on anything.
This was especially strongly
compounded during Melbourne's second, interminable lockdown.
There were days I found myself
scheduling long pauses between sessions, simply so I could lie flat between
each session and decompress.
I encouraged my clients to take
breaks from work and use their personal leave for mental health reasons, and I
did the same sometimes, grateful for supportive workplace structures and
understanding managers.
Keep my secrets, please
Psychology sessions have always been
a confessional. People tell you things that they have sometimes never shared
with another soul and with a small number of exceptions, you hold this
information in sacred confidence.
Toward the end of the second
lockdown in Melbourne, the bulk of my clients seemed to tire of the
restrictions in the same week and started to skirt the restrictions to seek
some solace, respite, and company.
They would look at me anxiously and
pause, as they shared these tales of transgressions.
It was an odd balance to walk, to
understand and deeply empathize with my client's needs for closeness, joy and
freedom and yet to hold in mind the battling discourse of the disease, and the
'stay apart, stay together' message.
I also knew people who were so
anxious that they refused to leave the house at all and were so achingly angry
at people who were doing the "wrong thing".
I was tasked with holding this anger
too and understanding the deep fears of death, loss, and need for control that
it stemmed from while holding myself close to but apart from these feelings.
The need to balance, hold and honor
competing viewpoints and to find the truth in all of them and the meaning of
each viewpoint for each client is a relatively unique requirement for
psychologists and one I value and nurture.
It is also incredibly exhausting,
and requires that I contain my personal feelings while engaging in the
Holding trauma
Psychologists have held a good
portion of the world's psychological trauma during this pandemic.
One of my colleagues works at a
hospital and said that she recently realized she was running on adrenalin and
anxiety all of last year and is only just beginning to realize the impacts of
the pandemic on her own psychological functioning.
That is the nature of adrenalin, the
crisis response, and needing to hold yourself together to support other people.
The sacrifices we have made have
been very different to the very direct sacrifices my amazing medical colleagues
have made. We have not had to work night shifts, double shifts, been exposed to
COVID or had to intubate people and watch them die.
However, we have heard about all of
this second-hand, have held the pain of those who have experienced great
suffering and been separated from people they loved and contained the
collective anxiety, sadness, and despair of masses of others.
We have tried to model compassion
and strength, on days when we may have found it very difficult to get out of
bed ourselves.
We have (metaphorically) held
clients and equally, have been cheered and supported by clients.
During the third lockdown in
Melbourne, as I found it hard to manage my motivation, I started a session with
a client who told me, in good spirits, that some people he knew were running a
book on how long the lockdown would last.
I laughed, my spirits uplifted by
his humor and his capacity to seize some fun despite personal difficulties.
What a difficult job it has been.
What a wonderful job it has been.
Dr Ahona Guha, DPsych, is a clinical
and forensic psychologist in Melbourne, Australia. She writes about a
range of psychology topics at Psychology
Today. You can find her on Twitter and Instagram
