Counselling CYP in the time of coronavirus
BACP Children, Young People and Families, June 2020

Holding the school community

We all knew something strange was brewing – we were watching developments overseas – but when it hit our community, our school and our families, it still came as a huge shock. I work as a school counsellor and am fully embedded and integrated within the school pastoral system. Being part of the fabric of school life, I experienced the full force of the shock wave as the global crisis hit our school community, alongside my colleagues, our students and their families. Even as a seasoned school counsellor, I noticed how much I was personally reeling from the impact of this event – flooded with concerns for our school community, now, tomorrow and in the months ahead. On top of this, I was also overwhelmed by fears for my own family and my own life.

As it slowly dawned on me that school would likely be closed for many months, at least in its physical form, I felt sick with worry about the emotional state of the students that we would welcome back; the bereaved, the traumatised and those longing for normality, now lost to us forever. Curiously though, as much as being a member of a close school community generated a flood of anxieties, my involvement in witnessing and collaborating with fledgling responses to the crisis also soothed me and slowly returned me safely to the calmer familiarity of my thinking mind. Once there, I was able to start researching, taking advice, planning and repurposing the offer of school-based counselling to best serve our community. As many students are experiencing fear, distress and despair, it is frustratingly difficult not to be available in the usual way. It is particularly important to be able to adapt and provide some effective contingency support measures.

In our school, we have decided not to offer video or telephone counselling for the time being, due to concerns about confidentiality, safeguarding and GDPR constraints. Fortunately, we managed to facilitate ‘good enough’ endings with our clients; checking out their feelings around the current crisis and new enforced lifestyles, their needs from us or other agencies once isolated at home and how best to signpost services going forward. We are able to offer ongoing email support for our current clients and can still react to any safeguarding concerns through the usual channels. As with all change, however, once we started to adapt to the inevitable losses, we were able to focus on the unexpected gains of the situation and already some new green shoots of opportunity and healing are starting to show.

Even though our school-based counselling service, as it was, has been rendered temporarily defunct, we are now able to offer new ways of supporting our school community. We have more capacity to offer emotional support to staff and parents than before, through email and, hopefully soon, via video and telephone sessions. This may be for their own support or to help them support young people in their care. We contribute resources to the weekly wellbeing blog, which our school is sending out to families. And we can take time to reflect on our practice and develop our busy counselling service to further benefit our school community in the future.

Some of the most notable positive changes have come through the redevelopment of roles of other members of staff. Pastoral staff are in regular individual contact with tutees and vulnerable students, which has had a knock-on therapeutic effect for students who may have felt invisible, overlooked or unsupported previously. Social media and streaming services have stepped up to the mark generously and positively too, with a plethora of new support resources, ideas for healthy connection and memes for a therapeutic laugh. These initiatives have promoted a sense of belonging to counteract the disconnection from friends and ‘normality’ that students and staff are experiencing. We are in this together, for better and worse.

Some students have been relieved of social anxiety and academic pressures and speak of enjoying a simpler, quieter way of life, one in which parents are able to be present at home and more engaged. I am mindful that this is not everyone’s experience. This is a fast-moving, dynamic situation. We need to continue to hone what we offer, according to personal, social and national developments, so that we continue to provide effective support for our own client communities. I am very grateful for the help provided by BACP and other professional bodies through online training, webinars and information that is helping to keep our work ethical and relevant.

But even as we get to grips with this new way of life, as if the current situation isn’t disturbing enough, we all know that the discombobulation and challenges will continue when this is all over. As school counsellors, we will need to think once again about how we can best help our returned school community to slowly adjust, recover and heal.

Working therapeutically in lockdown

Lots of therapists have made a sudden move to remote working, in a context of immense change and uncertainty. For many, this has been an enormous learning curve, going from technophobe to online therapist, and from a belief that working online wouldn’t work for children, to a proficiency in doing just that. This is mirrored by a society making rapid adaptations to huge changes. I have noticed two recurring themes within our practice that therapists are learning to manage. The first is the realisation that we are working with clients who are facing exactly the same issues and difficulties that we are. Normally, we would not take on a client who has a trauma that precisely mirrors one of our own, that we have not yet processed and worked through. However, at this particular time, everyone is processing the same trauma at the same time. And this means that our clients bring things that cause us anxiety, and this is something we are learning to manage. In a recent session with a parent, they mentioned an aspect of lockdown that I had not considered. I could feel the anxiety rise in me and the pull to think through the implications for myself rather than stay with my client and their experience. I am finding myself working twice as hard to contain myself, in order to contain my clients.

The second issue is how to work with children and adolescents online. There has been a general assumption that this would only be possible with fairly eloquent adolescents who make use primarily of talking therapy. However, with the necessity to not ‘drop’ child clients during lockdown, a lot of thinking has been going on into how to manage remote work with younger people. So far, my colleagues and I have found that there have been better results than we thought possible. I was worried about how less verbal clients would manage. Some have used the telephone, which appears to have offered freedom and disinhibition, perhaps a little like the use of a couch in traditional psychotherapy. There have been a few for whom remote working has felt stilted and uncontaining. For these, we have made alternative arrangements; shorter sessions or weekly postcards until face-to-face therapy resumes. Surprisingly though, the majority of children and young people of all ages have made good use of remote working. Younger children have loved the opportunity for the therapists to see a bit more of their world; their pets, their bedrooms and their toys.

We have developed a new contract for parents which sets out issues particular to remote therapy. Considerations include:

• Confidentiality and the need for sessions to be absolutely private
• Software and technical information, including keeping the bandwidth of the broadband available to the client during their session
• Safety issues, such as having a home address for the client in the event that we would need to send emergency services to the address
• Rules about how the sessions can be conducted, such as leaving the computer in a static position and not leaving the room during session.

Once things have been set up carefully, we have had some really lovely examples of work taking place on video link. Many people have made use of the whiteboard on Zoom to play the squiggle game with their clients. People have managed to do some beautiful ‘mirroring’ games where both client and therapist manage to draw ‘together’ with separate pens and paper but make a final piece that fits together. And it remains fascinating that whatever the presenting issues were in therapy before lockdown, they continue to make their way into the work now. Those who struggled with social issues find themselves feeling more isolated as their friendships are not strong enough to continue at a distance in a meaningful way. Those who struggled with family dynamics find being in social isolation with them particular challenging. Those who were working through anxiety and depression are facing a world more anxiety provoking than ever, and their link with their therapist is a lifeline.

As the lockdown continues, it will throw up more challenges. Those who have strong, healthy families will manage well, will get creative, will enjoy their time together. Those families that were struggling before lockdown will struggle with the confinement, the isolation, the cut-off from support. So, I make a plea to all therapists to continue finding ways to be creative, to manage our own anxieties and to be available to our clients at a time when they need us most.

Time to pause and reflect

I don’t think words can capture the extent to which COVID-19 has impacted our lives. With daily life turned upside down and routines disrupted for an indefinite yet extensive period, enduring an uncertain state has not discriminated against age. I was just one month in to face-to-face private practice, offering therapeutic support to children and young people. Unfortunately, COVID-19 has halted my work, and with social distancing measures in place, all but one client has agreed to continue via online means, though for a very short period. My feelings of excitement, wonder and joy have quickly turned to trepidation and disappointment. The extended break will impact our therapeutic relationships and I am doubtful if my clients will resume counselling. On a positive note, social distancing has given me the opportunity to reflect on some of the issues raised in the short span of my private work. As a South Asian and visibly identifiable Muslim woman, I have an interest in working with individuals from a similar background, primarily driven by a motivation to support minority groups, due to their difficulties in accessing mental health support. An interesting learning point related to faith practices has been whether to observe the hijab during counselling. Not all Muslim females observe the hijab and I am not required to wear it in female company. As my private practice takes place within my own home, this also makes it unnecessary. However, I decided to wear the hijab to portray my identity and my professional attire. Interestingly, clients have flitted between wearing theirs and sometimes removing it completely during our sessions. I am reassured that they are comfortable doing this, and it has prompted reflection around identity.

The restrictions in place as a result of COVID-19 have halted physical connections, while simultaneously prompting us to consider how we connect with others on various levels. With video communication now providing an alternative to face-to-face counselling, I have decided to remove my hijab as a way to connect with my female clients, based on our identities as visible and non-visible Muslim females.

My work with young people has highlighted that while maintaining boundaries, the therapist offering something of herself can create a human connection which is vital to forging trust in the therapist-client alliance. Removing my hijab is a perfect example of this. This has created some interesting discussion and has enriched our therapeutic relationships. I am revealing a private part of myself and this has helped clients to see me as a whole person, which I believe is crucial during these extraordinary and difficult circumstances. Thinking about when ordinary life resumes, I have no idea if I will wear my hijab in client sessions. It may be that I can rely on the strength of face-to-face counselling to sustain our connection. After all, beneath our hijabs, we are no different from other counsellors, willing to form meaningful relationships, person to person.

Working with CYP online

‘Strange and unsettling times.’ ‘It’s unprecedented.’ ‘We’ve never experienced anything like this in our lifetime.’ Like me, you may have found yourself repeating these statements. I veer between a sense of anticipation around pausing and slowing down, disbelief about what is happening and a sense of being part of something which we are all experiencing together, even if we have different responses to it. I liken this time to a parallel, universal split – the bombardment of daily death tolls, panic, anxiety, separation, self-isolation and shutdown, while life continues, with nature awakening all around us. At the forefront of my mind in thinking about holding clients, is the desire to allow space for all the differing feelings and responses (both mine and theirs) and to be as creative, flexible and adaptable as possible, while continuing to provide a ‘secure base’. What I have found particularly interesting is how levelling this experience has been. We are navigating this at the same time as our clients and we are just as vulnerable. None of us are immune to what coronavirus is bringing to the surface.

Although I work in schools, I also teach, supervise, and work privately. Most of my private clients have migrated online. The majority of those I see in schools have not. I relied on my supervisor’s support and guidance to make the move to online working and have cascaded resources to supervisees and trainees. Some of my supervisees, who are trainee child counsellors and therapists, have experienced closed doors; suspended placements in schools and organisations, with no idea of when they might see their clients next. It has been difficult to bear witness to these impingements, which apparently fail to take into account the importance of the therapeutic relationship at a time when it is needed the most. I have found this both disappointing and enraging. But I have been inspired by my supervisees’ creative ways of keeping connected with their clients when online working has not been a viable option, such as making and sending cards and sharing short video clips that parents and young children can watch together. As a seasoned clinician, I miss being in the child-friendly therapy room with the sand tray and figures, games, art materials and other resources, and I think the clients miss that too. Hurrah for the whiteboard function on Zoom! There was a palpable sense of relief, in both myself and the clients who predominantly work non-verbally, in discovering that we could still play alongside each other.

I have always maintained that therapy can happen anywhere, as ultimately we are the therapeutic tool. However, sitting behind a screen for a number of hours was not what I had in mind. I find myself being distracted more easily and less able to tune in to my somatic countertransference responses and sense of being embodied; ways of being that I rely on and that anchor me in my usual face-to-face practice. It is still early days and I’m being gentle with myself. I imagine I’m entering the ‘conscious incompetence’ phase, and after working therapeutically and supervising for a number of years, that feels a bit strange. I have discussed with peers how exhausting I find working online, compared with being in the room, and others seem to share the experience.

Coronavirus is the predominant subject of many sessions, and generally my clients seem to be taking it in their stride. Many have expressed relief at not taking exams or not being in school, as these are triggers for them. They are enjoying being able to slow down, rest, be with family, take time to exercise and eat well. A few young people have also expressed that it’s reassuring as it’s not their issue, it’s a global one – and that has lightened the load.

I am feeling my way, wondering whether I’m being ‘good enough’ for my clients, wondering how to stay creative, playful and enlivened behind a screen and wondering, am I still me? I’m also enjoying listening to the birds between sessions, witnessing the red kites swirling in the sky. Therein lies the rub; everything has changed, yet nothing has changed. 

Working with CYP via text

Coronavirus turns out to be an excellent teacher. One of the many things I have learned so far is that any assumptions we might make about therapy for children and young people may not be very accurate. As the slightly cringeworthy saying goes, don’t assume, because ASSUME makes an ASS out of U and ME.

As the UK’s COVID-19 crisis deepened, and schools worked towards closing their physical doors, my organisation planned that staff would check in weekly by phone with the young people currently accessing our one-to-one counselling services. Unfortunately, the tablet computer issued to me wasn’t allowing me to make phone calls. Our IT team were contacted, and assured me they were on the case – but what to do in the meantime? Luckily, the text app on my tablet was working, and text messaging was how I offered ongoing support for young people during the early weeks of social distancing and lockdown. I was initially apologetic that I couldn’t phone and speak with young people directly. But almost to a fault, they quickly let me know that they would prefer text to voice contact anyway – and please could we carry on talking by text, even if my phone got fixed? Some even seemed to find it easier to share things by text than by talking with me face to face in our counselling room.

Like many others, my organisation decided that offering a means of support which closely mirrored face-to-face contact would be preferable during the school closure period. And this was a reasonable assumption to make – from an adult perspective. But young people’s social norms are different, and asynchronous communication (stop-start conversations that happen in separate ‘bits’, rather than in the continuous, real-time dance of utterance and response, as happens in person or on the phone) is a regular part of most young people’s day-to-day lives. I wonder whether, at a time when so many things felt outside of young people’s sway, the control afforded by text messaging gave some sense of agency and power; by text, they could decide not only what to say but also when to say it.

Telephone counselling with CYP

There is one thing you can usually count on from a school, especially a large state secondary: a boisterous mass of humanity, whose shrieks and giggles bounce through corridors in overpowering waves during the brief pauses between lessons. But now the corridors are mostly silent. We have all been sent home, apart from a skeleton staff and a handful of students; mostly children of keyworkers. The usual routines of ensuring good attendance are out the window, along with so many others. Staff and students have been ordered to stay away and wait for this strange season to pass.

Now we work from home. But what does that mean for a school counsellor? For me, it means working from a Victorian two-bedroomed house, with my husband and nine-year-old son. Spaces of solitude must be actively created, negotiated, dismantled and then recreated the next day. The tiny shoebox of a room under a staircase at school had its faults, but our counselling room was wonderfully predictable: the familiar posters, the cupboard of games and art supplies, the books and figurines on the shelves provided a steady backdrop for each counselling session. They provided a secure base, in Bowlby’s sense, for clients, but also for me. My rituals within that space helped me to feel congruent enough to meet my clients as they were, with a steadiness which was essential to an effective counselling relationship. On the last Friday before school was shut, I filled my briefcase with files and books and bid farewell to that room, officially for just a few weeks, but we all knew it would be longer than that.

At first, I was daunted when I looked at my list of clients and their contact information, sitting in a corner of my bedroom, which I had claimed for my counselling base at home. I stared at the cherry blossoms outside the window, delicate yet raucous with their abundant frills of pastel pink. My husband was doing maths with my son downstairs, several doors were shut and I knew I would not be disturbed. Now was the time to reach out. What were my clients doing, I wondered? Would I be an unwelcome intrusion into their lives? For some young people, I only had parental mobile phone numbers. Although I knew which parents had given consent for their children’s counselling, I felt shy about speaking to them. What if they resented me? What if my speaking with parents embarrassed the young people, even if their parents had given permission? I had to accept these possibilities and move forward regardless.

Things were simplest with those few clients whom I had been able to speak with face to face before school closed. I called them on the phone, using 141 to withhold my personal number to help maintain professional boundaries. I asked how they were, but was aware of how easily it would be to slip into a polite conversation which was far removed from our usual exchanges. So I commented on the strangeness of it all, blathered on about the cherry blossoms and the beauties of spring, but also shared my perceptions of the fear in the air and asked what they had noticed in the past week or so. Before long, we fell into a rhythm, and in spite of the new circumstances, it was clear we were the same people, still curious about each other, still wondering aloud, still reflecting on feelings and making sense of the world together. I was pleasantly surprised to find myself warmly received by parents I had never spoken to before. As I heard them calling out their children’s names to summon them to the phone, I reflected upon what a peculiar privilege it was to be welcomed into their homes. Sometimes the parent or grandparent woke their napping teenagers, and sometimes they thought better of it. If I couldn’t reach them immediately, I left a message encouraging the young person to email me, so we could arrange another time for me to call.

The most difficult relationships to manage have been those with students I have only met with once, or never before, who have recently experienced significant trauma. I fervently want to help them, but I have not yet had the chance to earn their trust face to face, and this is a real obstacle. I am working together with the pastoral staff who referred the young people to begin with, communicating on the phone and via email. They already have relationships with the families involved, and they are encouraging the young people to contact me. I can only hope they will take up the opportunity. But if they don’t, I won’t blame them (or myself). Without the sanctuary of the actual counselling room, and physical distance from prying eyes and ears, what I have to offer therapeutically is diminished. It really is that simple. Meanwhile, there is no shortage of work to be done, fortifying myself to engage with each day as it comes, and working creatively with those students who do feel safe enough to have sessions on the phone or online.

For some young people, the closure of school amounts to a reduction in their worries. Exams have been cancelled. Bullies who seemed unavoidable are now kept at a distance. That teacher who had it in for them must no longer be faced on a daily basis. For others, particularly those who live in very close quarters with others who are struggling and may even be abusive, closure of school amounts to something much more frightening. We, as school counsellors, are called upon to use our existing relationships and communication technology to reach out and keep our clients company, emotionally and intellectually, if not physically. While teachers send course packs and update websites with the latest lessons, counsellors can use the tools they have to keep therapeutic momentum going. Although we might feel disoriented by the changes wrought by COVID-19 and measures to halt its spread, we are uniquely situated to let our clients know that we still hold a space for them. Reaching out and reaching in: we have our work cut out for us.

Finding our new normal

COVID-19 has loomed large in my private psychotherapy practice. Not because of the practical changes, though these came fast and hard. The young people who I work with zoomed (literally – I had not heard of Zoom before last week, but they pointed the way) onto online platforms, happily tackling the transformation from body-to-body to screen-to-screen. The looming came in the form of the dark and complex existential issues that arose from clients during the first weeks of lockdown. Dealing with uncertainty was the primary talking point. Negative capability is often a challenge for those affected by mental health issues, such as anxiety and depression. Keats described negative capability as being, ‘When a man is capable of being in uncertainties, mysteries, doubts, without any irritable reaching after fact and reason’.¹ Facing what the media have ominously termed ‘lockdown’, with restrictions on freedom and civil liberties, provoked uncertainty and doubt as to how to survive this strange new reality. Young people reported feeling threatened and disturbed as they attempted to come to terms with their new, isolated normal.

I am not usually a fan of the word ‘normal’, but normal life as each young person had known it was distorted. Most reported that their sense of time was different. Days seemed to stretch indeterminably into one another, and nights were dreaded. Most reported sleep disturbance and many mentioned distressing dreams. In reality, parties were cancelled, festival tickets left un-bought, tickets for football matches refunded, holidays postponed, GCSEs and A-Levels aborted and grades left up in the air. Students were sent home from university a term early, but course fees still had to be paid. This new reality induced both sadness and relief as they settled into isolation, followed by a healthy dollop of grief. Young people in education often experience their agency, power and autonomy threatened by parents and teachers, but in the face of the unseen risk of COVID-19, the helplessness and fear that I have witnessed in sessions has a more despairing and hopeless quality; anger first, then a submissive relief at having food and health.

I wonder if now, more than ever, issues of equality and collaboration need to be urgently addressed in our academic communities. The historian and philosopher Yuval Noah Harari supports the move to artificial intelligence in medical care and predicts that education and social care will look very different when this is all over. He says that we may never return to the present in the form that it existed a few weeks ago.² With our future health and liberty effectively in the hands of the international scientific community, perhaps it is time to consider the efficacy of competition and hierarchy. My own research³ draws attention to the need for researchers to collaborate and share information across disciplines. I called for specialities to be generous in sharing information. Now, more than ever, as we face a selfish, deadly virus, information needs to be shared in order for advances in medical practice to be made. Perhaps ‘equality is better for everyone’⁴ and collaboration rather than walls is better for us all.

Determined to gain some agency and power for myself, I have distributed the chores in my own home – my own personal revolution! I only take sole responsibility for cooking one day out of seven – it’s working well, with some participants even showing excitement about their turn to cook. I am cleaning only as much as the others in my home. Admittedly, this did not evoke eagerness or enthusiasm, but I did pick up on the hint of satisfaction as one member of the family admired the shine they’d achieved on the bathroom tiles. I’m not sure how long my freedom from domestic servitude will last, but maybe in the face of this great uncertainty, taking small steps towards freeing ourselves is all we can do right now.

Due to lead times, contributions to this article were written in March/April

Please share your experiences of providing therapeutic support during lockdown and afterwards, with me at cypf.editorial@bacp.co.uk