pandemic

Article links, Current Events, Self-care

Hoooo-nelly… We’re still here. And we’re going to be here a long while yet (she says, eyeballing the again-rising numbers in Ontario and the ongoing dumpster fire that is COVID responses and shenanigans one month from a presidential election south of the border). And winter is coming — insert ubiquitous Game of Thrones graphic here — and shit’s about to get very, very complicated. (Not that COVID wasn’t already complicating everything, so I’m not really sure how much worse it can get… no. I really shouldn’t invite that kind of chaos. It can ALWAYS get worse.)

We’ve cruised over the six-month mark in this current pandemic, and it is taking its god-awful toll on all of us in some way or another. Not too long ago, someone pointed me to this amazing description of “the six month wall” by University of Toronto prof Dr. Aisha Ahmad. For those who prefer not to scroll through Twitter stories, she encapsulated her thoughts in this article, and there’s a decent Forbes article exploring her ideas. Dr. Ahmad’s experience working in disaster relief is, I think, a good parallel for what it’s like for many of us struggling to find footing and balance under the weight of an ongoing pandemic, albeit one a growing number seem inclined to ignore as a threat. She provides a very balanced look at both how tough getting over the six month wall can be and also what has worked to help keep forging ahead when we hit those difficult slumps and ruts.

The idea that in an ongoing, persistent crisis state, we’re all going to hit a slump in our struggles against that state just makes sense. Some people have been struggling with the fear of infection and illness since COVID first started spreading in North America; some are less worried about the virus itself and more concerned about the short- and long-term impacts of protracted social distancing. Others might be most impacted by grief and grieving those they cannot get to under quarantine restrictions and travel embargoes. Long story short, for one reason or another (or many reasons all at once), a great many of us have hit an exhaustion point. We’ve been struggling to adapt to this new scenario in all its implications since March; it’s been at best a challenge and at worst an utter shitshow. We’re breaking down mentally and emotionally stalling out.

As she points out, most of us have already adapted to some degrees of the “new normal”, but winter is going to require us to adapt again to the new challenges of COVID resurgence WITHOUT the benefit of warming weather and outdoor escape options. That we’re hitting the six month wall now, as those seasonal implications begin to really hit home for many, is doubly harsh. I don’t about other mental health workers, but I don’t even know how to predict what my work is going to look like come the holidays under COVID, and the aftermath heading into deep winter. I can’t imagine it’s going to be pretty. Humans are naturally adaptable on an evolutionary scale of things, but a lot of us don’t actually enjoy change when the necessity of it is thrust upon us by factors beyond our control (personally, I get grumpy about change even when it IS 100% in my control, so… there’s that.)

“[T]he wall is real and normal. And frankly, it’s not productive to try to ram your head through it. It will break naturally in about 4-6 weeks if you ride it out.” – Dr. Aisha Ahmad

Aye, there’s the rub… riding this slump out for another four to six WEEKS.

A later Tweet by Dr. Ahmad explores a little more deeply her concept of mental “shore leave” plan to help make it over the six month wall:

Mental shore leave means a psychic retreat. So my task is to get creative about where I can create respite in my life today, just as it is. It also means looking hard at where I can set boundaries, and cut out negativity & noise. The goal is simple: optimize rest and joy. /4

A key factor will be ensuring that my shore leave plan does not depend on anything staying open. If my strategy is about going to a gym or bookstore, it will be vulnerable to collapse. I need my respite to be absolutely untouchable. /5

On the whole, I am deeply onboard with this idea. The idea that we’re allowed to put down the load of “life in wildly-uncertain times” is seductive, if only because sometimes *I* just want someone to give me permission to stop worrying about things for an hour or two. Even half an hour! My only caveat is that, as presented, there is no allowance for those who have spent the last six months sliding down into depressive cycles that make adding ANY extra efforts to their day a difficult challenge, even respite time. As a therapist, in the past week, I’ve been shaping those conversations with clients in this slump as exploring their definitions of “respite”. For some, it has meant finding ways to increase literal rest or looking for ways to reshare/rebalance some of their workloads to provide relief from at least SOME of their stressors. For others, it has meant the deliberate, temporary delay of dealing with all manner of issues and circumstances that might be a lower priority than basics of safety and survival. For many on the depressive spiral, myself included, it has been a discussion about allowing ourselves a respite from some of the less-important things we believe we SHOULD be doing, and giving ourselves permission to make rest and recovery our highest priority as much as our circumstances permit.

The pandemic may be unrelenting, but how we engage with it need not be. I like Dr. Ahmad’s notion of respite breaks, but I would prefer seeing a more grounded approach in introducing that notion to our struggling clients especially. Most importantly, I really appreciated seeing someone outside of the therapeutic/mental health field validating and echoing what I’ve been noticing lately in discussions with my own clients… and experiencing in my own head. The wall is real, the slump is not exactly short-term but it IS temporary, and we DO have options for disengaging from it for whatever periods of time we can muster for respite.

I might just get myself and my clients through the next 4-6 weeks, then, given all of that.

Current Events, Life Transitions, Mental Health

So there we were, six months into a pandemic, trying to pretend the world was getting back to “normal” in spite of COVID numbers slowly creeping back up in the wrong direction, a race war brewing, backlash against militarized and violent policing growing, an American election fiasco in the making, questionable political decisions on our own side of the border…

No, wait. Not “were”. ARE. Here we *ARE*.

Today in Ontario, many schools reopened their doors to returning students without a clear plan on how to manage classrooms under pandemic conditions. Parents, teachers, and school staff alike have been dreading this moment since things closed down in March; next to actual lockdown adjustment crises, that’s been the second or third most common issues walking into my (virtual) office for the last month or so. Even for those of us without kids but with an excellent understanding of science basics, there’s a sense of a timer ticking, and this year it’s not just about the surge of the usual colds and health issues that come from children playing together as children do. It’s all the OTHER infection vectors that are now in play.

And yes, we’re concerned. We’re concerned about how best to continue to support our clients and our communities while keeping ourselves, our colleagues and office staff, our offices, and yes, our clients and everyone to whom YOU are connected, as safe as we can. We’re still being advised by our governing colleges to avoid returning to in-person sessions for the foreseeable future, so virtual meetings continue. Six months into things, we’re still not back to normal operations, nor will we be any time soon.

Our clients continue to be graciously understanding for the most part, but they’re as frustrated as we are. We’re still helping folkx navigate a world where jobs are still disappearing as businesses falter, where pandemic/lockdown fatigue and social distancing remain considerable barriers to mental health, where “Zoom fatigue” and the normalization of working from home creates a whole new set of challenges to work/life balance routines. We’re trying to figure out how best to help our seasonally-affected clients prepare for the autumn and winter in the absence of most of their normal social options. And we’re trying our best to make sure we as therapists don’t succumb to this tidal bore ourselves.

All of which to say, six months on, we’re still here, still working, still doing our best to support where we can, validate and commiserate where we can, change what we can, offer what hope and perspective we can… And we know that some days, many days even, will be harder than others. We can’t make any of this go any faster, we can’t predict what life will look like in The After, and we don’t always know what will make it easier to get from Here to There either. But we’re in the mud with everyone else, and we get it.

Stay strong, stay safe. As the clich? says, especially at this point, “The only way out is THROUGH.”

Current Events, Mental Health, Practice News

So, here’s another truth about being a therapist at this particular moment in human history (last week’s behind the curtain view was a humorous one; this one’s a little more serious). Most therapists work from what’s called a “trauma-informed” perspective, meaning we are “treating a whole person, taking into account past trauma and the resulting coping mechanisms when attempting to understand [current] behaviors and treat the patient.” We also take into account the differences between trauma as a disruptive event, and complex trauma, which is “a psychological disorder that can develop in response to prolonged, repeated experience of interpersonal trauma in a context in which the individual has little or no chance of escape.”. In other words, we’re good at coming in when the client is ready to do the work of unpacking or changing the way past events have, or continue to disrupt their current life.

…AFTER THE FACT.

We sometimes get lucky enough to be available as someone is processing an event in progress, like working to escape an abusive relationship or dealing with a loved one as they are dying. But even in those circumstances, we’re on the outside of the experience looking inward, a stable neutral presence that can help anchor and support clients in distress.

Hard truth time: ain’t none of us trained to deal with global epidemics and crises on this scale AS THEY ARE HAPPENING and AS THEY ARE ALSO HUGELY IMPACTING *US*.

We sometimes get called in very soon or immediately after a crisis event happens, but we’re not usually enmeshed in it ourselves. Right now, however, we’re supporting our clients and colleagues (many of whom are themselves in identical unfamiliar circumstances) in working through virtual channels, working from home, dealing with children and partners underfoot all the time in quarantine… while dealing with exactly those same issues ourselves. As I wrote last week, we’re all in this together, but like medical health professionals, having been determined by the government to be “essential services” therapists are ALSO working long hours to make sure we keep our own shit under wraps enough to be an effective support for our clients right now.

I don’t tell you this to make us seem like superheroes, because I can assure, we’re still pretty human (see last week’s post for proof of that). I tell you this because there’s a need to understand that while we’re doing the best that we can, we’re really not trained for this, either. Many of us are cobbling together what we know of trauma care with what we know of working with high anxiety and (where appropriate) basic CBT tactics to hold the intrusive, fear-laden thoughts at bay. The problem is, when we’re living through an honest-to-god global pandemic, the actual worst-case fears and risks are both absolutely legitimate, and pretty terrible… and the clients aren’t the only ones seeing that. The therapists are living and breathing those concerns and fears right alongside you.

The definition of complex PTSD keeps coming back to me as I watch people adjust to the new normal, including a persistently-high state of stress/worry/concern/anxiety/fear about the what-ifs. When you’re living in a dangerous time, there isn’t any form of escape other than to just “live through it”, no matter how long it takes. And being in that persistent state over the longterm always exacts a toll; it’s not going to be the same for everyone, nor will it manifest in the same timeframe for everyone. But it’s there. And we have to take that into account when we’re dealing with ourselves and our clients, not just in the future and after the fact, but right now. Today. In this moment.

The best tool I’ve got right now is working with people to normalize and validate everything in their maelstrom of feelings; to shorten down their personal event horizons and look specifically, and exclusively, at what is in their power to do TODAY? What will make them feel better TODAY? It’s not that I don’t want to sustain a sense of hope for the future, but we have to keep hope in the context of daily-fluctuating uncertainty. We need to frame it in an understanding that our current heightened state of curve-flattening mitigation tactics will take WEEKS yet, if not MONTHS, to drop the infection rate back to near-zero (because as long as there IS a new-case reporting rate, we ALL remain at risk; that’s just how viral pandemics work). I’m watching friends and clients intellectualize that timetable, but the truth of what their lives will look like is barely just starting to take hold on an emotional level, especially knowing that the pandemic is only the trigger for an economic crisis of equally epic proportions to come. This kind of uncertainty really eats away at a person’s sense of grounding and control.

It eats away at ours, too. Trust me on that.

We’re in a high-stress, high-uncertainty scenario not of our own making and even less under our control. The odds of this crisis *creating* complex trauma responses for a large number of individuals is likely high, because it’s a longterm situation and it’s inescapable. The challenge for us as therapists is that we can’t wait for this scenario to be over before we’re needing to put boots on the ground and be effective. We can’t wait until we get ourselves clear of this scenario before we wade in to offer support to others. When I say, “we’re all in this together”, I mean it quite literally. As therapists, for once we are not apart from your crisis; we may have our own responses to what’s going on, but we are also up to our eyeballs in it. We’re as uncertain, as stressed, as anxious, as terrified, as exhausted as you may be.

And we’re still here. If you need us, we’re keeping the lights on for you as long as we can, and hopefully all the way through.

(Both my home office and Bliss Counselling are still open and seeing clients, BTW. We’re only doing virtual sessions via Zoom or phone for the duration, but WE ARE OPEN!)

Current Events, Mental Health, Practice News, Self-care

People keep asking why I’m continuing to see clients in person both uptown and at the home office. It’s simple, really: the therapist’s office is the only safe space some people have. Many who might have used work to escape volatile, toxic, abusive, or outright dangerous home situations are now being told to stay home and not come to work — meaning they are trapped in the very situations that threaten them the most.

It’s unclear what protocols local shelters are enacting in a time of pandemic, but the anxiety levels around exposure and uncertain shelter occupancy arrangements will also serve to keep the vulnerable from getting clear of a dangerous home environment.

It’s the darker side of quarantine, isolation, and the desperately-needed social distancing practices: yes, we’re trying to flatten a curve and spare hospitals and treatment centres from overloading, but we’re also trapping some of the most vulnerable people in their own worst nightmares, caging them with their abusers for an indefinite period of time.

So yes, if my office is the one safe space that remains open to them, then I will take every precaution I can to protect us all for as long as I can. I will disinfect everything I can and keep to a reasonable distance across the room, but come hell or high water, for those that need us — we’ll keep the lights on for you as long as we safely can.