The current “COVID” era brings many changes also in the work of psychotherapists. During the first spring months of 2020, our office was completely empty. The ban on providing any services except “urgent medical care,” ordered by the UVZ, almost completely paralyzed our counseling and therapeutic activity. After several desperate phone calls with people in crisis, we finally returned to work at the beginning of May. Many new clients appeared, and both the forms and content of our activities changed.
Just as in many other professions, we too have partly moved to distance forms, mainly online consultations via web applications. On the one hand, we consider this form of contact to be limiting; on the other hand, it has the undeniable advantage of removing the requirement to wear a mask. In psychotherapeutic work, not only eye contact but also overall “face-to-face” contact is essential. Perceiving nonverbal signals from a masked client is extremely demanding, and this certainly applies to other colleagues in helping professions as well. A conversation via computer allows these signals to be perceived at least partly (depending on where the camera is positioned), but there is a lack of the feeling of “human warmth” from physical closeness and touch—the nonspecific factors that cannot be measured or weighed and yet everyone feels how important they are for each person. That is why lately we increasingly prefer individual contact with clients, while we let their need to protect themselves with a mask or not be decided by their own choice, regardless of external regulations.
As far as problem areas are concerned, changes have occurred there as well. Some child patients with psychosomatic problems etiologically linked to school began to recover almost “miraculously” during homeschooling. As an example, we mention an 8-year-old pupil for whom, because of a severe aversion to the class teacher (I note mutual aversion), we requested a transfer to another class, without success. In August 2020, the mother of this boy told us that psychosomatic symptoms (extremely severe eczema and abdominal pain persisting since first grade) had completely disappeared. It is remarkable how many parents managed to cope with home education, because it imposed high demands not only on their abilities but also on their patience. Of course, there were also those for whom home education caused problems, especially parents with several children. We discussed this together, tried to consider time constraints, optimize educational attitudes, and align them with the new demand of home teaching.
In couple and family counseling, we also noted changes. Additional problems associated with the “submarine”—the need to spend a long time in close contact, without the possibility of social, cultural, or sporting outlets—have appeared. Partners began to recognize their opinion differences more than before. If they had unresolved issues from the past, these became very aggravated. They needed to understand the nature of the crisis, stop blaming the other person for it, and learn new ways of coexisting. We strongly perceive how the crisis of the individual, couple, and family interweaves not so much with the health crisis as with the economic crisis of the whole society.
A separate chapter is the increase in the number of older school-age children who began experimenting with drugs during this period. Of course, this also concerns adolescents. In our clientele, for example, we have a 17-year-old boy whose mother brought him to us because of his apparent anxiety and depressive states, but she did not suspect that behind the problem was multi-year abuse of narcotics—in his case, a combination of medications (opiates) and various types of hallucinogens. When asked where he obtained them and from what financial sources, he answered that it was “quite simple, everything can be obtained through friends and the internet anytime.” He began using them already in the pre-COVID era, but now, with fitness centers closed and all sports clubs cancelled, he admitted it is significantly worse for him. “If I do not want to get bored, I will take something, even though I know it is actually harming me,” he said.
A frequent negative consequence brought by the new era is the number of clients who perceive the overall societal situation as psychologically unbearable, which is reflected in their fears about themselves, loved ones, family, and children. Help in handling emotional burden has become highly sought after in current psychotherapist practice. According to our experience, the Transforming Negative Experience into Positive (TTNPP) Technique has proven to be fast and effective, used to eliminate fear and other emotional problems. We previously presented it in the journal Prohuman (see Prevendárová et al., 2017; Derková, 2019).
Another issue brought by the new era is the increasing number of clients who find themselves in such isolation that their need is not so much to solve a problem as to talk it out—to find someone who values them, listens attentively, does not criticize, and does not judge them... In this context, we briefly outline the assumptions, needs, and, respectively, “orders” (requests for service) with which clients visit us. Those who come to our clinic for the first time have different ideas of what will happen and what they can expect from the specialist they chose. Usually they have preliminary information about the specialist from the web, family, or acquaintances. Most often they know what troubles them, but their request is often only weakly specified, ambiguous, or even unconscious. If the professional does not clarify the request from the outset and does not take it over with the client, unnecessary misunderstanding and disappointment can occur. This can happen not only in a psychotherapist’s office but also among doctors, who are used to proactively acting and addressing a patient’s health condition even when the person originally intended only to consult their problem and not to undergo a medical procedure or unwanted treatment. We know many such patients who cannot bring themselves to oppose this “authority,” yet eventually throw prescribed medicines into the trash. Why? Because their unspoken request was different from what the professional had assumed. From this perspective, we consider it key to examine the client’s expectation first at each meeting and proceed accordingly. In principle, in counseling and psychotherapeutic practice, we encounter four types of orders; each is linked to meeting a different need:
- Meeting the need to talk. The order (unaware and unarticulated without the therapist’s help) is this: “I want you to listen to me attentively. I do not want any advice, I just need you to understand me and share my world. I want to be able to lean on you with trust and share my burdensome thoughts and feelings.”
- Meeting the need to rationally understand a difficult situation and navigate it better. The order is: “I want you to look for possible solutions together with me. I want to understand what is happening to me/us and find suitable solution(s).” - Meeting the need to get rid of burdensome emotions, fear, anger, feelings of guilt, disappointment, and so on. The effort is to find relief from pain, whether physical or psychological. The order in such cases is: “I want you to help me get rid of my unpleasant feelings (fear, anger, sadness, pain, etc.).” These are clients who do not need rational explanations, advice, or lengthy conversations. They understand the situation they are in and its causes, but they are unable on their own to get rid of the emotional burden. In this regard, we note in our clinic an increased number of adolescents making various cuts and burns on their bodies, with an obvious intention to relieve unbearable pressure of negative emotions through self-harm. TTNPP is particularly useful for them, especially in the early phases of the therapeutic help process. - The client comes without motivation for change, often at someone else’s request. They are either passive, or in internal resistance to change. Their “order” could be formulated as: “I want you to let me be alone; this is not my problem”... Many family counselors and therapists likely have such an experience. As an example, we mention a scene we witnessed recently: we observed a mother forcefully pulling an 8-year-old boy out of a car, who was struggling in resistance and shouting that he was not going to any psychologist. It was the first contact with this specialist. We have similar experiences from couple counseling when one partner refuses to actively cooperate, even though they are present at the session.
As can be seen, sometimes a conflict arises among family members in their expectations and their explicitly or implicitly formulated order. A conflict between what the child wants and what their parent wants, or a conflict between partners/parents. In such cases it is essential to devote careful attention to this phase of the therapeutic process (the phase of listening and clarifying the order) and reach clear consensus. All participants should be satisfied, otherwise a process of positive change does not start at all, or it is blocked right from the beginning.
Conclusion
We are living in an extraordinary time that is changing society more than ever before. We remind that, in addition to the medical, economic, and legal help that the media usually focus on, professional mental health support is needed more and more often. Restrictive measures of the state, implemented with good intentions to protect us from infection, also have a significant impact on mental health and interpersonal relationships. Our motivation for writing this contribution was to draw attention to the specific problems we encounter in professional contact with clients and to share our experiences with the professional community in selecting new methods and forms of work.
Doc. PaedDr. Jitka Derková, PhD. Psychotherapy and remedial pedagogy clinic Therapeutic Center of Dr. Prevendárová, Ltd. Stará Vajnorská 37, Bratislava
References:
PREVENDÁROVÁ, J., et al.: New challenges in psychology. Nakl. Palma, Silúvky, 2017, 238 s. ISBN 978-80-904620-0-7
DERKOVÁ, J.: Family background of a child’s fear of school. Example of the “Technique for Transforming Negative Experience into Positive.” PROHUMAN Journal, July 2019. ISSN 1338-1415. Available on the web: https://www.prohuman.sk/psychologia/rodinne-pozadie-strachu-dietata-zo-skoly