Infectious Disease,  Mental Health Awareness

Lockdown: A therapist perspective

I distinctly remember the last working day I had at my private clinic. I locked the door shut behind me. The uncertainty of everything stood before me in the form of that locked door, one I would not be able to enter through…for how long? I did not know.

As I write this, India is 31 days into the lockdown and counting. Everyone’s emotional and mental health has been unpredictable—this is an unprecedented time. For me, the thought of navigating work, family, and being at home seemed overwhelming so I choose to not think and just do. I feel it’s true for many people out there. Being able to consciously engage in mindfulness activities comes from my years of experience and constant continuous consumption of self-care techniques. I never knew I relied on them as much as I do now. Equipped with my degrees and lessons from my clients I’m marching through the lockdown, and my experience has been more or less “delightful.”

For once, in a city like Mumbai that works on its own Indian Standard Time, I am not running late. There is no traffic to deal with, no constantly horns blaring.  The anxiety associated with the commute between hospitals and clinics no longer exists. I now plan my day based on me, my lunchtime and teatime, and not Mumbai traffic. With work travel limited to me moving from my couch to my desk, I begin my first session completely calm and composed.

With the added 3 hours in my schedule I read, exercise, learn and write. Albeit I may not do all of this every day but they find their way into my weekly schedule without too much shuffling. Being able to engage in these activities has contributed to reaffirming my confidence. The relationships around me feel more wholesome because I now have time to nurture them. It is strange to think of all that I can achieve from the couch, in my living room, and not necessarily my therapy room. Naturally, with this time to learn and reflect, I feel my ability as a therapist has grown.

Technology is the unsung hero of COVID-19. It’s also the sole reason why I can continue my practice. Skype, Zoom, FaceTime, and Whatsapp Video are the key players supporting the forever present Google Calendar. Being able to schedule appointments directly with clients, with regular reminders and no scope for forgetting has made me punctual. The reliability associated with this creates a sense of assurance and grounding needed during these tough times. It has added a level of organization that I had to previously rely on paid apps or on a person. Even the added feature of sending a note with the reminder has ensured clients remember to do their homework between sessions.

For clients with anxiety or depression, the change in routine or even forming one is a struggle. Technology, aided with all the extra time, helps in this process. Five weeks into using these tools its safe to say that clients are responding well to these changes. Using online calendars to schedule the day with reminders has been an unexplored area for me. The reminders the clients receive are subtle, do not nag, and can be rescheduled if needed. Using technology in the therapeutic process is something I have always wanted to do, but now I actually have the time to learn the ropes. Even gratitude exercises were easily completed moving the sense of responsibility to the client and accountability to the therapeutic journey. The exercises I use have now moved from a pen-paper model frequently used in therapy to a digital diary ensuring clients can go back and refer at any point – this ensures no one is losing their therapy journal, a heightened sense of privacy, and resources that can be used forever.

But it’s not all easy. Despite these advantages of online therapy, there have been some challenges.

There isn’t a therapy session that I have not begun with “can you see me” or “can you hear me” or “your screen has frozen.” The technical glitches of an unstable internet connection and software compatibility issues have made me creative with therapy – at times I switch between video to audio and if I’m lucky back to video during sessions.  While a stable and fast Internet connection is something India is still figuring out, I have created a backup of multiple video conferencing options and access to high-fiber Internet connectivity and two different cellular networks that can give me access to hotspot. This is the basic requirement of any online therapy. Any online system.

A primary concern for most of my clients is the distractibility and instant gratification of the Internet. Now that the therapy is taking place on the Internet’s playground, my client can simultaneously have multiple windows open. They jump between social media profiles and chat with their friends. It took me a while to catch on to this: I had my awakening when I saw the reflection of my client’s Instagram timeline in her spectacles. A couple of tricks I learned along the way is being attentive to the tapping noise of the keyboard, asking the client if they could rephrase what we discussed, and requesting them to share their screen. To be honest, the distractibility of the Internet is something that frequently tempts me too, and using the screen-sharing mode ensures I walk a straight path.

The video calling technology even allows clients to change the backgrounds on their video calls but honestly, none of my clients have. For which I’m glad. This creates a sense of intimacy in therapy that could never exist; them inviting me into their private spaces. Seeing my clients’ red cupboard, dream catchers above her beds and dragonfly drapes made me fill in the color in their jigsaw puzzle minds.

Most of my clients have been coming to me for a few years now. In India, almost all our concerns start with our upbringing. And staying confined with those key contributors is creating a whole new level of emotional distress. One client had to go to her terrace for some privacy and another went to her promenade for a session. Even though their respective families knew they were actively seeking therapy they felt unsafe in their own home. The difficulty of creating a safe space for clients in a virtual session is my biggest struggle. Things I often took for granted like ensuring a tissue box was there or calming aromas that instantly allowed the client to feel safe in the therapy room are no longer there. Even the ride to and from therapy was time clients unknowingly dedicated to reflecting on their week and subsequently on the therapy session. Not having this time has been my biggest loss as clients are now thinking about the next call they have to get on, or have not fully disengaged from their breakfast table conversation. It requires an additional 10minutes to set them in their zone and wind down for therapy. Being mindful of the therapeutic journey during those 60minutes has required a bit of workaround for me, where I’m learning to now account for the transition period the client would need in therapy.

The silver lining of this lockdown is that it has made a lot of sought after courses and services accessible at no or lower cost than before. This has greatly helped me as a professional to learn from experts all over the world and access content that would have been otherwise extremely expensive or require a lot of coordination. Hoping to utilize my skillset in a similar fashion, I started providing a no-charge support session for those dealing with COVID-19, made working on the self-creativity by providing a collective journaling course free, and volunteered at other organizations. This has resulted in many requests coming in from social media for appointments for non-corona cases, but each one looking for a discount. This adds to my guilt, something I personally battle with when billing clients. Are my sessions too expensive? I’ve taken similar sessions in the past at a much lower cost, haven’t I? Can’t I do the same again, here? Expensive remains a relative term. I know as a professional I have grown. It is justified for me to charge more because of my experience and skill, but what is the right thing to do at such times? There are some clients I still see for a cost 1/4th of my regular fees because I believe they have no other option and cannot afford anything more. My fear lies in the fact that in these trying times as we support each other’s emotional and mental wellbeing to build a sense of community, we don’t disregard everyone’s means of survival and livelihood.

As my own therapist says we are not fortune-tellers. So I will not look into the crystal ball and decipher what lies ahead. But this lockdown has opened a lot of closed doors for therapy online, and it is a medium I am getting comfortable using and will be actively making it part of my journey as a therapist. I hope, you do too.



Meet the author
Priyanka Varma Clinical Psychologist
She believes emotional and mental health care are at the very core of us experiencing happiness in our life. Her qualifications include a Masters in Clinical Psychology and in Counselling and Psychotherapy. Priyanka enjoys working with young adults and understanding life as it changes with intrusions like the internet and the pandemic. Above everything else her true love is homemade chocolate cake.

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