The big issue: How we are changed
Therapy Today, December 2020

A year is an artificial construct. Most of the major events over the past 12 months were already seeded, if not ablaze, well before 31 December 2019 – the bushfires in Australia, Brexit and the early signs of COVID-19; then there was the murder of George Floyd, the Black Lives Matter protests and, overshadowing all, the massive death toll and worldwide lockdown due to the spread of the coronavirus.

The impact has been a collective trauma – one that therapeutic professionals are a part of but also need to rise above if they are to be able to attend to the fear, anxiety and existential crises of their clients. Overall, the immediate response – rapid transition to remote working – has been something the profession can be proud of.

But what of potential longer-term effects? We spoke to therapists who are considering what our profession may need to be aware of in the year ahead for collective healing to take place.

Questioning consumerism

As 2020 opened, the bushfires in Australia were already rampaging, consuming 18.6 million hectares of land and some 6,000 buildings (half of them people’s homes) and killing at least 34 people. Wildlife too was affected – an estimated three billion terrestrial vertebrates died in the fires, and some species may have been driven to extinction. Then, in September, the wildfire season in the Brazilian Amazon began, and yet more acres of the world’s ‘green lungs’ were devastated. These, and the wildfires this year along the West Coast of the US in August and September, are a natural annual occurrence, but this year they were more intense than ever before. They are widely agreed to be exacerbated by climate change due to agricultural and industrial development.

Linda Aspey MBACP, executive coach and climate change campaigner, says people are finally making this connection between climate change, industrialisation and the growing urgency for real change in how we live and care for our planet. Lockdown heightened our appreciation of the clear skies and birdsong, but few have since changed their behaviours in any lasting ways, she fears. ‘Human nature responds to immediate threat to self and locality but we find it hard to sustain this response in the longer term. We don’t want to disrupt what we’ve got. We aren’t equipped psychologically to deal with existential angst on a daily basis so, naturally, we try to resist it. But there’s also plenty of research showing that social capital – the coming together for a common purpose – increases in times of crisis. People kept saying during the spring COVID-19 lockdown, “Let’s not lose this”.’

So how do we talk to clients who are grappling with this conundrum? Says Aspey: ‘We have bought into an equation that money means happiness and material possessions mean you are worth more. I’d say, “If that equation doesn’t add up for you, what would you do differently? What are the gains for you and future generations from living differently?” It’s humbling when people really connect with these questions.’

Beyond limits

Humankind is in what psychiatrist and philosopher Karl Jaspers called a ‘limit situation’, says existential psychotherapist Emmy van Deurzen – a point where we confront the narrowness of our life now and are forced to take the risk of plunging into a new way of living and thinking, if we are to survive. ‘If we can face it and become aware of the value of all that we stand to lose at the moment, we might go into that transformation that happens after a crisis and thrive, learn new skills and come out stronger and much wiser about the things that truly matter in life. That is my hope,’ she says. ‘Let’s be decent and good to each other, let’s agree what matters and let’s build a better world out of that.’

Van Deurzen is one of the estimated 3.5 million EU nationals living in the UK whose rights of residency were questioned by the Home Office following the Brexit vote. She was, finally, successful in forcing the Home Office to climb down, but the experience has left her shaken, angry and worried by the growing isolationism in the UK as we move towards Brexit on 31 December.

Yet she is also hopeful. ‘Ironically, because coronavirus has forced us to isolate and be socially distant, it has also made us aware that we need each other, that we have to work out our problems with each other rather than avoiding each other. And that is something we know from counselling and psychotherapy, especially when we work with couples and groups. We are social animals and we have to find a way of talking to each other because when we stop talking and start fighting or defending against each other, that is when things go wrong.’

We are, as a nation, desperately in need of effective leadership, says Hetty Einzig, leadership coach. Author of The Future of Coaching: vision, leadership and responsibility in a transforming world, she has a transpersonal psychotherapy and psychoanalytic background. ‘This year has been a prime example of the mess we are in around leadership and how we revert to primal behaviours in a crisis. When we are anxious or afraid, our focus narrows and we have a tendency to seek what soothed us in childhood. And what generally soothes us is this idea of a paternalistic, or maternalistic, figure who will fix everything and make it all OK.’

What we really need are caring leaders who also help us be more adult, Einzig argues. ‘When the whole globe is in a state of rampant fear, uncertainty, weariness and confusion, you want to feel that your leaders care about you deeply (not just about themselves and their own comforts). This is demonstrated through listening and being supportive, but also challenging and setting ambitious collective goals that feel achievable and include everybody. People have to feel they can participate and contribute.’

Einzig has coached leaders across the spectrum, including politicians. ‘I think there is a lot to be gained from long-term partnerships in coaching – standing alongside the client and saying, “I am your advocate and part of that role is to challenge you.” And a primary task of the coaching relationship is, I think, to help leaders learn to respond rather than react: “Rant as much as you like and then let’s be still.” In a crisis the reptilian threat reaction of fight, flight, freeze kicks off, which closes down thinking. The capacity to pause, breathe, regulate the nervous system and restore thinking is something all leaders need.’

Black Lives Matter

When George Floyd was killed in May, the shock waves were felt worldwide. White counsellors and psychotherapists in the UK found themselves forced to confront their own feelings of discomfort and shame. In the months since, that initial groundswell of shared grief, anger and openness to reflection and self-questioning has fragmented and dissipated. There is, says Dwight Turner, integrative psychotherapist and senior lecturer at the University of Brighton, a backlash – an attempt to make out that Black protest is itself a form of race supremacism. ‘We are starting to see a pushback. And, at one level, why wouldn’t it be there? Race is a binary construct, a relational construct, and when persons of colour stand up and start to speak, of course those who are white will feel challenged in their white identity. I get it when people say “All lives matter”, but I also hear their resistance to accepting that there is something in themselves that they are going to have to challenge in the future.’

But white allies are also asking what they can do to make things better within the profession: ‘There is a recognition that this is something we have to do together – these things will only change if we act together, and that to me is a positive,’ Turner says. ‘Systemic change has to happen, and at all levels, not just in training. We need to be thinking about how we reach out to disadvantaged communities to recruit the next generation of therapists. None of us is saying we have all the answers but there’s a sense that we all have a responsibility now to do our part. It isn’t just up to Black people.’

COVID-19

But, of course, overshadowing these other events, and likely to extend well into next year and beyond, is COVID-19. ‘We are all grieving because our world has been so changed by COVID-19,’ says John Wilson, Director of the Bereavement Service at York St John University Counselling and Mental Health Clinic (CMHC), and an honorary research fellow of the university. The pandemic has, he says, thrust us into a state of what psychiatrist and bereavement specialist Colin Murray-Parkes called ‘psycho-social transition’ – a period of crisis when our ‘assumptive world’ – the world we know, our interpretation of the past and our expectations of the future – is snatched from us and we are forced to create a new way of being and relating in a new ‘life space’.

Wilson estimates there will be more people needing specialist bereavement counselling because of the circumstances of many of the deaths in hospitals and care homes – the trauma for family and friends of being unable to support the dying and say goodbye properly. ‘I’m optimistic that, in most people’s cases, humanistic counselling and meaning-making will alleviate all but the worst kind of trauma. But I estimate, and studies to date seem to agree, a further 30-50,000 people will need specialist bereavement counselling in the coming months,’ he says.

He hopes an important lesson from COVID-19 is that we will all, as a society, be better able to talk about death. ‘I hope it doesn’t happen that bereaved people feel ghettoised and that, when life returns to normal, people just won’t want to know.’

Online revolution

Perhaps the most notable and universal change for the therapeutic professions this year has been the abandoning of a long-standing shibboleth and the rapid shift to working online. Says Anne Bentley, Chair of Heads of University Counselling Services (HUCS) special interest group and manager of the student wellbeing services at the University of Plymouth: ‘It’s very heartening to see how our services have revolutionised their modes of delivery to ensure students and staff can continue to have contact. It’s been a huge mind shift and culture shift, but we have proved to ourselves that we can turn our services around very quickly and still hold onto the meaning of what we do and the passion for what we do, and work in a creative and engaging way.’

Sarah Worley-James is former chair of the Association for Counselling and Therapy Online and, before COVID-19, offered both online and in-person therapy. She welcomes the shift and thinks it marks a sea change in counsellors’ attitudes to using digital technology in therapy – whether working with video, text or email. ‘I forecast a much more blended offer to clients in the future,’ she says.

But she warns that counsellors will need to pay far more attention to self-care if they do more screen work – partly because of the temptation to squeeze in more clients, partly because there is a tendency to underestimate the intensity of the work, and partly because counsellors too are deeply, personally affected by the issues clients are likely to be bringing to therapy right now.

This has certainly been the case for one BACP member, who preferred not to be named. She had, she says, been reducing her caseload anyway, because of burnout, in the months leading up to the March lockdown. Then COVID-19 really hit and she found her own OCD retriggered. She became very anxious about contamination and terrified to go out in case she caught the virus.

‘Living in a one-room flat, I found it really intense. I’d be sitting in one chair to eat my dinner, another to watch TV and another for all my social contact and work with clients, all in the same tiny space. I felt quite zoomed out. My burnout symptoms were finding the work overstimulating anyway, and the screen work exacerbated that. It was only when my caseload dropped to two or three that I felt I had some headspace to sort myself out.’

Private practitioners have been able to access government grants for loss of earnings and premises rental costs. But, as Kris Ambler, BACP Workforce Lead, reports, not all have been eligible: notably, those who are new to self-employment and those who are directors of their own company. There have been cases of real hardship, he fears, although BACP has not heard of many instances, and has been able to refer members on to expert advice and sources of help.

Mental health crisis

There is a plethora of research studies currently under way looking at the impact of COVID-19 on population mental health and the likely implications for our mental health services. Among the more cataclysmic is a report from the Centre for Mental Health, published in October, which predicted that up to 10 million people (almost 20% of the population) will need either new or additional mental health support as a direct consequence of COVID-19.¹ Some 1.5 million of these will be children and young people under 18.

A study by researchers at the University of Glasgow has also warned of a possible increase in people attempting suicide.² Based on research with 3,000 people between 31 March and 11 May, the study found suicidal thoughts increased from 8% to 10%. Rates were highest among young adults (18-29 years), rising from 12.5% to 14%. One in four respondents experienced at least moderate levels of depressive symptoms, with young people, women, people from socially disadvantaged backgrounds and those with pre-existing mental health problems most affected. The increase in suicidal thoughts, while small, is worrying the researchers say, because of the rapidity of the rise. Lead researcher, Professor Rory O’Connor, Chair in health psychology at the University of Glasgow’s Institute of Health and Wellbeing, warns: ‘Suicidal thoughts are about looking to the future. It suggests that the huge social and economic uncertainty associated with COVID-19 may be causing some people to feel hopeless.’

But we should be wary of jumping to the conclusion that a mental health pandemic is next on the horizon. The COVID-19 Social Study of psychological and social impact of the pandemic, which has been conducting weekly surveys of more than 70,000 people since the March lockdown, paints a more nuanced picture.^3,4 It found that mental health deteriorated rapidly at the onset of the March lockdown, but the negative effects stabilised and people’s self-reported mental health began to improve as they adjusted to the ‘new normal’. The COVID-Minds Network concluded the same in its October briefing:⁵ much of the deterioration was due to the specific circumstances. We are more resilient than we expect and believe.

Says independent psychologist Lucy Johnstone: ‘We all have extremely good reasons for feeling more worried, more anxious, more depressed right now. To immediately translate that into the language of mental health is unhelpful. It serves to distance us from our feelings and from the causes of our feelings and so makes us less able to think about what we can do about them.’ She argues that, rather than turning to mental health services as a first resort, ‘we need to be thinking about how we can individually and collectively be in touch enough with our feelings to put some of our anxiety and concern into productive action without being so overwhelmed that we feel paralysed and helpless.’

Children and young people

The impact of COVID-19 on children and young people’s mental health is also clear from an NHS Digital report published in October.⁶ It specifically singles out COVID-19 and lockdown as contributing factors to an increase in the rates of children with ‘probable mental health problems’ from one in nine to a new high of one in six between 2017 and July 2020.

The study finds that a protective effect during the pandemic seems to be receiving regular support from school or college. Seeking but failing to get help made mental health problems worse, the study reports. Says Jo Holmes, BACP Lead for Children and Young People: ‘The findings echo what we have been seeing out in the field. BACP’s survey in July of 700 school counsellors found that the numbers of children and young people receiving school counselling halved during lockdown, either because the school closed or the children couldn’t access online counselling, for a variety of reasons – sometimes digital poverty, sometimes lack of private space or because the counsellor couldn’t offer it.’

She predicts a spike in numbers of children needing counselling. ‘In some cases, COVID-19 has magnified existing problems; in others it has prompted new anxieties about the future, where they fit in, family relationships, parental jobs and income. For most, it’s been a period of huge uncertainty and the long-term effects will, I think, be devastating. Are services equipped to be dealing with this?’ she asks. ‘Intervention by a school counsellor can help, particularly when part of a whole-school approach and working systemically. The one positive about COVID-19 is that it has provided a platform for all the stakeholder organisations to call for more funded school and college counselling in England, in line with the rest of the UK.’

The rush to rescue

Early on during the initial lockdown, there was some heated discussion between BACP members about volunteering and whether qualified counsellors should be offering their services for free in a period of crisis, either to support NHS volunteers or to make their services more available to people struggling on the margins of society or falling through gaps in government support. BACP’s advice was that it is up to public sector employers to ensure their staff are properly supported, although it fully understood members’ wish to contribute in some way.

This urge to help in a time of crisis needs careful thought and reflection, says Jelena Watkins, a psychosynthesis psychotherapist who specialises in disaster mental health and has been supporting survivors and relatives affected by the Manchester Arena bomb.

‘COVID-19 has demonstrated how we as a profession really have that strong hook to jump in and help, and it’s a very noble and altruistic motive, but it’s not always the best response for us,’ she says. ‘One of the reasons is we really need to be long-distance runners, and, in my experience, we are best working over the longer term, rather than in the thick of the crisis. The impacts of these collective traumas tend to linger and sometimes even crop up much later and they need stamina and can be quite exhausting as the recovery stage can be very protracted. We need to pace ourselves for that rather than rush in at the beginning.’

And it can be unhelpful, she warns: ‘Not all of us are qualified to do grief and trauma work – we aren’t qualified to be all things to all people. I don’t want to be critical of people’s altruistic motives, but we need to think about our motivation to join the heroic response and to be very honest with ourselves. Is it always altruism, or is it competitiveness with other professions – do we want to be seen to be relevant?’

She worries too that counselling may be colluding with the medicalisation of distress. ‘But throwing counselling at people when it is a result of social injustice or political problems, we risk atomising the issue down to the confidentiality and secrecy of the counselling room. I question whether that is the right way to move forward. As a profession, that is our edge: not to collude with turning societal distress into a psychological issue but to think more creatively about how and where we apply our skills. We could be working more with groups, because collective trauma requires collective healing. Should we not be going out into our communities and creating groups to address societal issues from a psychological perspective, which we have a lot of tools for? That is what I’d like to see post-COVID-19 – more attention to this broader role of psychotherapists and counsellors as community builders, facilitators of connectedness and community efficacy, not just confining ourselves to one-to-one work in our consulting rooms.’

Collective healing

This is a very limited look back at the events of 2020, but one overriding message seems to come from these interviews: that from crisis can emerge new growth and change. Let’s not go back to normal; let’s work out what we really value in life, collectively as well as individually, and be guided by that. As Watkins says: ‘People have a huge resilience and ability to adapt. So, as we brace ourselves for a difficult winter, let’s use that time for incubation of new ideas for doing things differently so we go back to normal in a better way.’

She also believes that collective trauma requires collective healing. ‘People are talking about “Build Back Better” and I think this is where we might contribute as a profession,’ she says. ‘Instead of looking just at individual lives and individual issues and healing, we can contribute through working with individuals to support collective change. We need to recognise people’s feelings of despair and anger not as a problem but as seeds of action. We are uniquely equipped to hold these feelings and encourage appropriate action as people move to become active change agents, because collective crises often act as a catalyst for collective change.’

The experiences we have shared during the past 12 months will shape us, our clients and the society we live in for a very long time to come. We can only hope that some of the lessons we have learned will stay with us to guide us into a better future. Counsellors and psychotherapists have an important role here, to keep us connected with those values and beliefs.