Nick Johl is a clinical psychologist based in the West Midlands. Here, Nick reflects on his work during lock-down and the various challenges he has been presented with.
As a clinical psychologist who works with vulnerable children and adults, lockdown has had a varied impact on my role. The majority of my role is visiting care homes to support children in care. When lockdown came in, this was the first thing that was postponed.
This meant that for young children so used to receiving psychological support, this had to be put on hold until we could find more meaningful methods. As the world began to adopt Zoom and Microsoft Teams were able to offer direct therapy as video calls.
However, the quality of the therapy sessions were affected by the lack of physical presence and losing the ability to read body language more accurately. For the vulnerable children in particular, we took the clinical decision to reinstate direct therapy sessions.
We navigated this by adopting the daily government guidance, regular risk assessments and introducing changes in practice. This included seeing children all in one day and then self-isolating for the rest of the week. Gaps between therapy sessions for clean downs of the space and apparatus used. Directives given to young children to wash hands on arrival, temperature checks taken and the reminder of social distancing.
For some of the young people in therapy, the presence of health precautions contained their anxiety and allowed them to engage in the process. For other children however, the concept of no physical touch, having to remain 2 metres apart was actually sometimes seen as a rejection from their therapist and their engagement in sessions suffered.
Moving onto the adults I worked with, Covid brought the same barriers in terms of accessing the physical presence of a therapist. However it did appear that adults who were responding to work commitments via Zoom calls and Microsoft Teams adjusted well to now having therapy via the same platform. It allowed adults to remain in touch with their therapists and also gain support. What had to capture in more detail where the client was living, their local support networks and their local emergency services. This was in relation to managing risk of a client who may not live local to your therapy space. The use of video therapy means clients could be engaging from another country.
The biggest theme which came out from the therapy sessions during Covid lockdown were anxiety regarding health and the risk of death. This was in relation to the client themselves and also for their loved ones. In addition to this, there was a strong theme of stress, feeling out of control and also loss. Loss of coping mechanisms, loss of routine, hobbies, structure and freedom too.
These early themes then shaped my assessment process in therapy. During lockdown I would spend specific time assessing the impact of Covid on their mental health, how they manage change, understanding their coping mechanisms and also how they are functioning during lockdown. I would ask more details for quality of relationships, their current routine, relationships with alcohol consumption and more.
There was a clear correlation between two things during lockdown. One was that for some, Covid had been the clear trigger for their mental health difficulties which for some they had never experienced prior to the pandemic. Two, that for many, Covid lockdown magnified existing mental health difficulties and issues that the client may have been managing “ok” previously.
In my clinical opinion, as we ease out of lockdown, for the majority, our mental health will begin to improve. This will be due to the return to routines, restrictions of hobbies and interests being lifted and we are able to engage in more of our support networks.
However, this will also bring new anxieties in accepting the “new normal” and the anxiety of social distancing, wearing masks and being encouraged to engage in previous life-styles.
Lastly, lockdown will no doubt bring new clients to therapy. In particular key workers who have had to remain so resilient throughout all of this. As they begin to ease away from the critical and frontline nature of their role, I predict presentations of burnout, low mood, PTSD and complicated grief for the brave key workers.
