Counselling clients affected by the COVID-19 pandemic

Hello!
My name is Dr. Shishir Palsapure, and I am a certified Rational Emotive and Cognitive behaviour therapy supervisor and trainer. I want to congratulate you for taking up this step in the direction of improving the mental health of people affected by the COVID 19 Pandemic. In the upcoming course, I have compiled small lectures on a variety of topics and easy tests at the end of each section. These tests will help you check your own understanding of the topics discussed, and keep you on track. If you did not understand a topic, you can always go back to the section and view the lecture again. I recommend you that you don't jump topics as the lectures are built over the previous ones, and you might find it difficult to comprehend if you have skipped a few topics.

I hope you can put the learning to use immediately after completing the course. I strongly recommend that you back up your learning by reading the recommended books, and consider supervision by a certified supervisor in your region or online. So let's get started!

Laying a good foundation to therapy.

Right from the first time the client starts communicating with you, you are laying a foundation for therapy. Your initial interaction helps lay a good foundation.

Explain the scope and limitations of therapy

Check the client's expectations from therapy, learn from their previous experience with therapy if any, and clarify your role. You can help them deal with the problems better, but cannot solve practical problems for them, nor offer them data about the pandemic. You cannot offer them any advice about medication, supplements unless you are licensed and allowed to do so in you region. You shall also clarify your role in case of high risk eg. an infected client who has not reported to the officials, or someone is feeling suicidal. You need to check with your local governing bodies including psychological associations about these ethical considerations. Ethical considerations are different from region to region, and hence excluded from the course.

Establishing goals

Ask the client "what problem would you like to work on in today's session?"
This passes on many important messages.

1. The therapy is active directive

2. The therapy is problem-goal oriented

3. The client is going to work on the problem

4. You may work on different problems in different sessions

Clients typically will narrate their practical problems eg. having been exposed, home quarantined, too much work, boredom, drug/additive substance withdrawal etc. Your role at this stage is to help them understand that they might be emotionally disturbed about these problems. Certain negative emotions will interfere with problem solving, shift focus, cause distress and reduce functioning. Working on these emotions will help them deal with the adversities better.

You shall be helping them reduce emotional distress, help cope with the adversity better, teach them skills to help themselves and others better, improve functioning and manage symptoms of emotional disturbance.

Ask for specific feelings they want to work on. Eg. Anxiety, depression, anger or specific behaviours eg. not waking up on time, procrastination. Set a goal of an alternative emotional or behavioural reaction. Eg.  To feel Concerned but not anxious, Sad and disappointed but not depressed, or to be more proactive, to stop ruminating, to stop procrastinating etc.
Set an emotional or a behavioural goal.
Emotional Goals-

Set alternative goals for dysfunctional negative emotions.

Depressed >Sad but not depressed

Unhealthy anger>Healthy anger

Anxiety> Concerned and not anxious

Guilt> Responsible and not guilty

Shame> Disappointed with self but not ashamed

Hurt>> Disappointed at others, but not hurt

Hopeless> Realistically optimistic

Unhealthy Jealousy> Healthy jealousy

Unhealthy envy> Healthy envy

Set either reduction/stopping or escalation of some behaviours as a goal

Eg. Avoidance> To increase or decrease, whatever would be helpful

Rumination> Reduce or stop

Exercise> Increase

Questions like "What would you like to achieve from therapy/counselling, what would you like the outcome of therapy to be, how would you want to change your reactions to what has happened/is happening/to the possibility that it will happen?" can speed up the process.

Make sure that the goals are concrete, measurable, realistic and largely helpful to the client and the significant others in the family/society in general.

Set short term and long term goals. Set timelines and observable milestones/change in behaviours. 

Clients typically will narrate their practical problems eg. having been exposed, home quarantined, too much work, boredom, drug/additive substance withdrawal etc. Your role at this stage is to help them understand that they might be emotionally disturbed about these problems. Certain negative emotions will interfere with problem solving, shift focus, cause distress and reduce functioning. Working on these emotions will help them deal with the adversities better.

Therapeutic alliance is the agreement and willingness to work on problem(s) in a professional setting. Learn how to build and protect the alliance.