Common Reactions to the COVID-19 Crisis: Fear and Anxiety

Aside from worrying about the COVID-19 crisis, many people are concerned that their reactions make them feel "weak" or "abnormal" or "crazy," but most of the reactions that people are describing are common and many people are experiencing the same reactions.  In a prior article, I discussed the common reaction of grief during this crisis.  In this article, I'm discussing fear and anxiety in an effort to normalize these feelings (see my articles: Coping and Staying Calm During the COVID-19 Crisis, Accepting Your Negative Emotions During a Crisis, Common Reactions During the COVID-19 Crisis: Waves of Grief and Empowering Yourself During the COVID-19 Crisis).

Common Reaction to the COVID-19 Crisis: Fear and Anxiety

A Common Reaction to COVID-19: Fear and Anxiety
Many people are trying to make sense of their reactions to the current pandemic.  Since we have never experienced anything like this during modern times, it's sometimes hard to know what to feel or to distinguish one emotion from another.

First, let's recognize that there's a difference between fear and anxiety.  Briefly stated, fear is about a known event and anxiety is about an anticipated event (for a more detailed explanation, see my article: What's the Difference Between Fear and Anxiety?).

Some people talk about feeling "strange" or like they're in a "Sci Fi movie."  Many people feel the surreal nature of the experience as they try to grapple with the enormity of the crisis.

Along with many other common reactions, fear and anxiety are the ones that most people mention.  It's easy to understand why people are fearful and anxious on many different levels due to concerns about their

• Health
• Emotional well-being
• Children and grandchildren
• Jobs
• Financial situation
• Future prospects

and so on.

Self Judgment and Self Criticism About Feeling Fear and Anxiety
People who wouldn't ever think to judge someone else for being fearful and anxious often take a harsh stance with themselves about feeling the same emotions (see my article: Self Blame and the Internal Critic).

They think they should do better, especially if they grew up being a parentified child where they took care of their parents emotional well-being instead of being taken care of by their parents (see my article: Children's Roles in Dysfunctional Families).

These are people who, as children, had a heavy burden placed on them which was far beyond their development, so they're accustomed to having unrealistic and unreasonable expectations of themselves.  Unfortunately, these unrealistic expectatons don't stop when they become adults.  They continue to have the same patterns.

Many of them might have internalized a critical voice from one or both of their parents who might also have been parentified children to their own parents, so this appears "normal" to them.

Children who grew up being parentified children often just can't give themselves a break.  It's not unusual for them to think they have to do things and react to things in a "perfect" way, and anything that's less than perfect isn't good enough (see my article: The Connection Between Perfectionism and Shame).

Using Defense Mechanisms to Avoid Feeling Fear and Anxiety
Many people use one or more of the following defense mechanisms to avoid experiencing their emotions (see my article: Understnding Defense Mechanisms).

• Denial About Fear and Anxiety: For many people, acknowledging their fear and anxiety makes them feel too vulnerable.  Instead of acknowledging their feelings, they deny them instead, "I don't feel fearful or anxious.  What good would that do me?"  So their feelings get swept under the carpet and often manifests in physical or psychological ailments, like headaches, bodily aches and pains, depression and so on.  

• Rationalizing Away Fear and Anxiety: Another reaction that I often see is for people, who are harsh with themselves, compare themselves to others who are much worse off than them, "I don't have any reason to feel fearful or anxious.  Look at Mary, she has it so much worse than me."  They don't recognize that Mary's situation doesn't negate their own and that they're entitled to their own emotional reactions.  Instead of allowing themselves to feel their emotions, they minimize their reactions by comparing themselves to someone who is much worse.  However, if we carried this to its logical conclusion, each person could find someone who is much worse off as a way to blame themselves for having what turns out to be a common response (see my article: Rationalization as a Form of Denial and Self Deception).

• Projecting Their Fear and Anxiety onto Someone Else: Instead of allowing themselves to feel their emotions, people who use projection project them onto someone else, "I'm not feeling anxious or afraid.  You're the one who feels that way."

• Intellectualizing as a Way to Avoid Feeling Fear and Anxiety: People who tend to intellectualize as their defense against feeling fear and anxiety are usually able to talk about crises in terms of facts, logical, and data.  But they are too uncomfortable to talk about their emotions because it makes them feel too vulnerable.

How Does a Person Learn to Accept Their Emotions Instead of Defending Against Them?
One answer to this question for many people is to receive psychoeducation in an article like this that their emotions are a common reaction to the current situation. Also, if they talk to another people about it, they will often hear others say the same thing.

People who have unresolved trauma will need more help.  They need to work through their childhood trauma first to have some self compassion about their current emotions.

On a logical level, many people who were parentified children can see that it makes sense (logically) that they feel as they do.  But on an emotional level, they still judge themselves, and that's the old trauma getting triggered, "You should be able to deal with this without feeling afraid of anxious."

Getting Help in Therapy
If you have a history of trauma that is getting triggered now, working with a trauma therapist, who can help you to work through the past trauma as well as helping you with your current fears and anticipatory anxiety, will allow you to cope better.

Many psychotherapists, including me, are doing online therapy sessions (also called telehealth, telemental health and teletherapy) during this period of time (see my article: The Advantages of Online Therapy When You Can't See Your Therapist in Person).

Rather than struggling on your own, seeking help can help to alleviate your fears ans anxiety.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP and Somatic Experiencing therapist who works with individual adults and couples (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

As previously mentioned, I'm currently providing online therapy.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Common Reactions to the COVID-19 Crisis: Waves of Grief

During the current COVID-19 crisis, many people have told me that their grief about the crisis, which is similar to the grief that you might feel for other losses, comes in waves (see my article: Grieving Losses During a Crisis).  They told me that they might feel fine one moment and then they suddenly feel a wave of grief pass over them.

Common Reactions to the COVID-19 Crisis: Waves of Grief 

Waves of Grief During a Crisis Are Common
Just like any other loss, the grief that people are feeling during this health crisis is real and understandable.  So much of life, including in-person contact with loved ones, has been upended, and this is a significant loss.

The fact that no one really knows how long this crisis might last can intensify your grief.  For instance, if you knew that the crisis was going to last another 30, 60 or 90 days, you would have an idea of when you might experience light at the end of the tunnel. However, at this point in time, although there are various projections, no one seems to know for sure when this pandemic will end in the United States.  So, it can feel like it's endless and the losses are permanent.

Emotions often come in waves.  When I'm working with a psychotherapy client and doing trauma therapy, I usually can expect to see the waves of emotion--whether it's sadness, fear, anger, or whatever emotion the client is experiencing.

Before doing trauma work in therapy, I provide psychoeducation about the work, including how emotions usually rise, reach a peak and subside.  One of things I do while working with a traumatized client is to track these waves of emotion as well as the discharge of these emotions by observing how the client reacts during therapy (see my article: Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About How Therapy Works).

When you cry, sigh, yawn or feel waves of emotion throughout your body, from a Somatic Psychotherapy perspective, you're discharging energy or emotions.  Although it might be unpleasant to go through a wave of negative emotion, it's usually better to allow yourself to feel it and allow it to go through you than to try to stop it because when you feel the emotion and allow it to discharge, you're self regulating your mind and your body.

Fictional Clinical Vignette: A Normal Response to a Crisis: Waves of Grief
The following fictional clinical vignette, which is a composite of many different cases, illustrates how grief is felt and discharged during a trauma therapy session:

Alice
When Alice learned that her husband, who was a firefighter, had died at the World Trade Center during the 9/11 attack, she was shocked and felt emotionally numb.  All she could think was that she was having a nightmare and any moment she would wake up and she would realize that it had all been a bad dream.

As her shock wore off a few weeks later, Alice felt very angry because she heard that her husband and the other first responders at the World Trade Center site didn't have the proper equipment to communicate with their superiors.  She felt such rage towards everyone involved because she believed that her husband would have survived if only he had the proper equipment.

She also felt rage when she heard that there had been warnings at the Federal level about the possibility of a terrorist attack that went unheeded.  From her perspective, she couldn't believe her husband was dead due to the incompetenence at such a high level.

She received a lot of support from the fire department's counseling unit as well as individual firefighters who worked with him, friends, family and neighbors. But she still felt alone and lonely as waves of grief washed over her.

A few months later, Alice decided to start therapy because she was feeling overwhelmed by the loss of her husband.  She felt enveloped by grief all the time, and she didn't have a sense of relief from it.

At the recommendation of a friend, Alice sought therapy with an experiential therapist who was a trauma therapist.  As part of the psychoeducation Alice received in her therapy, she lealrned that, in fact, grief comes in waves and she became more aware of periods of when her grief was heightened and when it had somewhat subsided for a period of time (see my article: Why Experiential Therapy is More Effective Than Regular Talk Therapy)

Before this, Alice hadn't paid attention to the wave-like experience of grief that ebbed and flowed.  Her therapist explained that similar to physical pain, emotional pain had a rise, a peak and a reduction similar to a wave.  Her therapist told her that many people who have physical pain can learn in therapy how to detect their waves of pain rather than believing that they have constant intense pain all the time.

Developing an awareness of the ebbs and flows to grief is an awareness that's similar to mindfulness.  The client learns to maintain a dual awareness of experiencing the pain (physical or emotional) at the same time that s/he is observing her reactions.

With guidance and practice, being able to maintain this dual awareness is a skill that can be learned in trauma therapy with a therapist who practices experiential psychotherapy.

 At first, Alice struggled with the observing part of the dual awareness.  She felt too immersed in her grief to do anything other than experience it.  But, over time, gradually, Alice learned to be more aware of her waves of grief as well as the dissipation or discharge of it when she cried, which brought emotional relief.

In learning to be more mindful of the grief she was feeling, it was as if Alice developed another part of her mind that was slightly outside the experience.  In psychotherapy jargon, this would be called "an observing ego."

Alice learned from her psychotherapist that:

• When we speak of an observing ego, we're speaking metaphorically.  It's not like we can physically locate an observing ego in the brain.  It represents a healthy split in consciousness where a part of the mind witnesses what's going on for the individual.  

• The observing ego allows us to perceive change in ourselves, and this is what allows people who are experiencing physical or emotional pain to witness their own experience.

• Not only does the observing ego allow us to witness our reactions and changes in our reactions, it also grants us a sense of agency and we feel empowered by it because it can guide us to do what's best for ourselves.

• Most people have an observing ego to a greater or lesser degree.  If you've ever had the sense of observing your reactions to a particular situation, your observing ego was at work.

• The ability to strengthen the observing ego can be learned in experiential therapy.

• There is usually a discharge, which can be very subtle, at the end of a cycle of emotion.  This discharge, which is often a letting go of emotion or subtle physical energy can come in different forms, including crying, yawning, sighing or feeling small waves of energy move through the body.

Being able to observe the ebb of flow of her grief at any given time, Alice no longer felt like she was "going crazy" when a tidal wave of grief came over her for no apparent reason.  Similarly, when she observed that she was feeling a little better or she was able to enjoy a visit with a friend or laugh at a joke, she realized this was also normal and it was part of the cycle of grief that she felt on most days.

After helping Alice to develop coping skills and techniques, her therapist talked to Alice about EMDR therapy to help Alice heal (see my articles: What is EMDR Therapy?,  How Does EMDR Therapy Work? and Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

As Alice continued with her EMDR therapy sessions, she still missed her husband on most days, but she no longer felt overwhelmed by her grief.  She also realized the periods of time when she felt on an even keel emotionally were getting longer and more frequent.  Gradually, her sense of relief expanded and she had more full days when she felt a sense of well-being.

Conclusion

Even though the fictional vignette above deals with the 9/11 World Trade Center attack, the concept of wave of grief applies to other losses and crises.

People experience grief when they go through major losses, whether it's the loss of a relationship, the loss of a job, a downturn in their finances, and so on.  Grief isn't only about death.

As mentioned earlier, grief is a normal and common response to loss.  Since the current pandemic encompasses losses on many different levels, both emotional and practical, it makes sense that many people are experiencing grief.

A wave is like a crescendo.  It has a rise, a peak and a fall.  Developing an awareness of this cycle and the observing ego to recognize it is part of experiential therapy.  

When a client develops this mindful awareness of their own emotional process, s/he experiences a sense of agency and control over herself and her emotions in situations that are often uncontrollable.

Getting Help in Therapy

Although grief is a common and normal response to loss, including the losses that many people are experiencing during this pandemic, attending experiential therapy, like EMDR therapy, Somatic Experiencing, AEDP therapy, and other forms of experiential therapy, helps you to heal faster than if you were to try to overcome it on your own or if you were in regular talk therapy.

An experiential therapist can teach you the skills and guide you through the grieving process in a way that you can't do it on your own.

Rather than suffering alone, help is available to you.

Many psychotherapists, including me, are providing online therapy (also called telehealth, teletherapy or telemental health) during the COVID-19 crisis while we're unable to do in-person therapy in our offices due to the need for physical distancing (see my article: The Advantages of Online Therapy When You Can't See Your Therapist in Person).

Working through grief with an experienced psychotherapist can help to alleviate your emotional pain.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, Somatic Experiencing therapist who works with individual adults and couples (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

Emotionally Focused Therapy is available for couples therapy.

I'm currently providing online therapy while I'm out of my office during the COVID-19 crisis.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Empowering Yourself During COVID-19: There Are Things You CAN Control

During the current COVID-19 crisis, many people are feeling powerless. This is understandable given the suddenness and the unprecedented nature of the crisis. Also, many of the social interactions, activities and diversions that would normally be available to people to support their well-being aren't available to them because people are physically isolated and might be lonely.  There are many unknowns about the future and it can feel like everything is out of your control.  But before you give into feelings of hopelessness and helplessness, let's take a look at the things that you can control (see my articles: Coping and Staying Calm During a Crisis, Coping with Loneliness and Social Isolation, and Undoing Aloneness: Staying Socially Connected Even Though We're Physically Disconnected).

Empowering Yourself During COVID-19: There Are Things You CAN Control

There Are Things You Can Control During the COVID-19 Pandemic
The Serenity Prayer, which was written by Reinhold Niebuhr, contains much wisdom and many people, both in and out of the recovery community, find it calming:

"God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference."

Regardless of whether or not you believe in a God, a Higher Power, religion or prayer, these words remind you that, if you're worried about things you have no control over, you can redirect your attention to what you can control.

What You Can Control During the COVID-19 Pandemic
Rather than focusing on what you can't control, let's take a look at some things you can control:

• Stay Informed But Don't Spend Too Much Time Watching the News: 
• Getting reliable information is important to staying informed. 
• It's also important to moderate how much time you spend watching or listening to the news.  
• Much of the news is repetitive throughout the day, and the benefit spending time watching TV or online news is often outweighed by how anxious it can make you feel.
•  So, you need to figure out what's best for you in terms of how much and when you watch the news.  
• If you want to maintain your overall sense of well-being, it's especially important that you don't watch the news before you go to sleep.

• Center and Ground Yourself: 
• Practice doing breathing exercises to help to calm yourself (see my article: Square Breathing to Manage Stress). 
• Practice online yoga at a pace that's right for you if yoga appeals to you. If you're not up to doing a vigorous form of yoga, there are online videos or chair yoga.
• Practice meditation at a regular time. Some people prefer to meditate at night.  Others prefer to meditate when they wake up, and some people do it two or more times a day.  You don't need any special knowledge to quiet your mind to meditate.  You can start by taking a few deep breaths to activate your parasympathetic nervous system, which will calm you down.  There are also many online meditations that you can follow (see my articles: The Mind-Body Connection: Mindfulness Meditation and Calming the Body, Calming the Mind). 
• Calm your thoughts by taking it one day, one hour or even one minute at a time.
• Recognize that all things pass.
• Feel gratitude and appreciation for what you do have right now. 

• Establish a Routine For Yourself: Chances are good that your normal routine has been interrupted since the current crisis began.  A routine can give you comfort and a feeling of stability, so you can establish a new routine for yourself:
• Wake up and go to sleep at the same time everyday.
• Plan your meals.
• Plan some quiet time for yourself, even if it's just a couple of minutes to breathe.
• Make a To-Do list for yourself for the next day so you don't spend all day either in bed or watching news
• A To-Do list can help to organize your day, your week, and your life.
• Try not to be too ambitious with your To-Do list.
• Be gentle with yourself. Recognize that you're probably not going to accomplish everything on the list--and that's okay.
• Appreciate yourself for accomplishing whatever you accomplish on the list.

• Stay Active: Even though you might be physically isolating, there are still ways to be physically active:
• You can find many free workouts and yoga classes online.
• You can also walk or bike outside as long as you take the precautions recommended to stay a healthy distance (at least 6 feet away) from others and follow The Center for Disease Control (CDC) recommendations.

• Accept the Ups and Downs You Feel as a Common Response to a Crisis: You're living through an unprecedented time in modern history.  Chances are that your mood will go up and down at various times. This is a common experience during times of stress and crisis (see my article: Overcoming Your Fear of Your So-Called "Negative Emotions".
• If you feel anxious, sad, fearful or whatever emotion you're experiencing at any given time, you're having a common response to a crisis.
• Rather than judging yourself, accept all your emotions and do whatever you can to alleviate your stress and negative emotions.
• Recognize that you're not alone.  Millions of other people, who are just like you, are experiencing the same thing. We're in this together.

• Eat Nutritiously: Eating the right amount of protein, vegetables, grains and vegetables is important to stay physically and mentally healthy.  

• Get Enough Sleep: Getting proper sleep is essential to your overall health and well-being (see my article: Tips on Improving Your Sleep).

• Stay Connected Socially: Even though you might not be able to see loved ones now, you can still stay connected to them via: 
• Phone calls
• Video chats  
• Games with friends online.  
• Video night with a Netflix Party

• Remember Your Strengths: Whether you realize it or not, your strengths have gotten you through stressful times in the past.  Remembering these strengths can be empowering to you now (see my article: Remember Your Strengths as a Way to Cope With the Current Crisis).

Getting Help in Therapy
Times of crisis can trigger prior trauma and stressors, and it can be difficult to determine what you're reacting to emotionally.  The important thing to know is that you're not alone.

An experienced psychotherapist can help you to get through a stressful time when you feel overwhelmed.

Many psychotherapists, including me, are providing online therapy (also called telehealth, telemental health, and teletherapy) during the current crisis when therapists aren't in their office (see my article: The Advantages of Online Therapy When You Can't Meet With Your Therapist in Person).

Rather than struggling on your own, you could get help from a licensed psychotherapist to overcome the obstacles that are hindering you.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, Somatic Experiencing and Emotionally Focused Therapy therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

I am providing online therapy during the COVID-19 crisis.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Tips For Getting Better Sleep

Getting proper sleep is essential to maintaining good health and emotional well-being.  This is especially true when you're going through a stressful time.

Tips For Getting Better Sleep

The Effects of Poor Sleep

Poor sleep can affect you by:

• Lowering your threshhold for pain
• Increasing your blood pressure
• Affecting your memory and ability to concentrate
• Compromising your immune system, which can increase the likelihood of getting sick
• Increasing the likelihood for impulsive behavior
• Increasing the likelihood for weight gain

Improving Your Sleep Hygiene: Tips for Improving Your Sleep Hygiene

You might not realize that you're not getting enough sleep beausse you've become accustomed to being sleep deprived.  However, if you're not getting 7-8 hours (on average) of quality sleep, you're not getting enough sleep.  Here are some tips for improving your sleep hygiene:

• Exercise at a level that's appropriate for you earlier in the day to relieve stress.  
• Go to bed at the same time every night, including the weekends.
• Avoid bright lights after the sun goes down.  Bright light will inhibit melatonin which prepares you for sleep.
• Sleep about 7-8 hours straight (some people might require more sleep or a little less).
• Don't do work in your bedroom. You want your brain to associate your bedroom with sleep.
• Make your bedroom as comfortable as possible:
• Regulate the temperature so it's comfortable
• Decrease noise
• Don't watch TV, including the news, in your bedroom.
• Don't eat a large meal 3 hours or less before you go to sleep.  Indigestion can interfere with your ability to sleep.
• Don't use alcohol as a sleep aid.  Alcohol might relax you at first because you'll get the sedative effect, but alcohol also disrupts your sleep routine because it will wake you up after a few hours.
• Create a wind down routine to prepare you for sleep.  This might include bedtime rituals:
• Brush your teeth
• Wash your face
• Take a relaxing bath or shower
• Drink a relaxing cup of herbal tea 
• Read for a few minutes before sleep can be relaxing and help you sleep.
• Write in a journal earlier in the day to capture any thoughts that might be worrying you 
• Don't judge yourself if you still can't fall asleep.  
• Give yourself 20 minutes if you're unable to sleep.
• If you still don't fall asleep after 20 minutes, go into another room and do something relaxing to see if you can go back to bed and get sleep.

Getting Help in Therapy

You're not alone.

If you're feeling overwhelmed, you can contact a licensed psychotherapist to help you develop the tools and skills that you need to achieve emotional well-being.

During the COVID-19 crisis, many psychotherapists are offering online therapy sessions during this period when in-office sessions aren't available.

Rather than struggling on your own, contacting a licensed therapist can make all the difference in your overall health and well-being.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, Emotionally Focused Therapy for Couples and Somatic Experiencing therapist.

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Undoing Aloneness: The Client's and Therapist's Parallel Experience of a Crisis

In a prior article, I began a discussion about undoing aloneness and what that means (see my article: Undoing Aloneness: Staying Socially Connected Even Though We Are Physically Disconnected).

In the prior article, I suggested ways that individuals could remain socially connected to loved ones, even though they are physically apart. I also discussed how therapists could maintain meaningful connections with clients through online therapy or phone therapy while they are out of their offices.

In this article, I'm focusing on the fact that therapists and clients are having parallel experiences of the COVID-19 crisis and how these parallel experiences can enhance therapists' ability to provide a safe therapeutic environment, which includes helping the client to feel that he or she isn't alone with the experience.

Undoing Aloneness: The Client's and Therapist's Parallel Experience of a Crisis

The Therapist's Clinical Judgement About Self Disclosure to Clients in Therapy During Parallel Experiences: Undoing Aloneness
In a prior article, I wrote about times when both the client and therapist are going through a similar crisis at the same time (see my article: Parallel Losses For the Client and the Therapist).

In that article, I discussed that therapists often find that a client comes to their office with a similar problem that the therapist might be experiencing at the same time.  I provided a fictional clinical vignette where a client, Lois, came to therapy because her mother was rapidly decompensating from Alzheimer's.

In this fictional example, Lois' therapist was able to provide both practical resources as well as clinical interventions to help Lois cope with her grief and fear about her mother's deteriorating condition.

Lois felt the calming and soothing holding environment that her therapist provided in her therapy sessions (see my article: The Creation of a Holding Environment in Therapy).  Even though Lois felt grief, she also felt her grief was being held and contained by her therapist and this was healing for Lois.

What Lois didn't know was that her therapist was also going through a similar experience with her own mother.  The therapist assessed whether it would be beneficial for Lois to know this and she made a clinical judgement call (to herself) that Lois needed to feel that her therapist was outside the world of Alzheimer's and nursing homes, so she opted not to tell Lois about her own situation.  She assessed that it wouldn't be helpful, so she didn't self disclose.

In another situation with a different client, the same therapist might assess that it would be beneficial for the client to know that the therapist was having a similar experience.  Self disclosure of this nature is, of course, done with much forethought and might even involve consultations with other colleagues.

The other consideration that must be kept in mind when the therapist and client are having parallel experiences is that, even though there might be similarities, there are also differences in the client's and therapist's situations.  This isn't a situation where there is "twinship" between the therapist and client.  Although similar, each of their situations will be unique and they will experience differences based on each of their particular situations and who they are as individuals.

The therapist has to make sure that any self disclosure, especially on this level, is for the benefit of the client and not for the benefit of the therapist.  This doesn't mean that the therapist might not derive some benefit or healing from it as a byproduct of the self disclosure, but the focus must be on what's best for the client.

Parallel Experiences During the COVID-19 Crisis and Undoing Aloneness For the Client
In the situation where a therapist is going through a similar personal situation to the client, the decision to self disclose or not, although not easy or done lightly, is easier to make, as compared to self disclosure in the COVID-19 crisis, because in the personal situation the client usually isn't aware of what's going on in the therapist's personal life.

But in the current COVID-19 pandemic, everyone is affected in one way or another, and most clients know this.  The therapist can't pretend that she's not affected by this crisis because the client already knows that everyone is affected, possibly in different ways and to a greater or lesser degree.

Similar to other situations where self disclosure is a clinical judgment call, during the COVID-19 crisis, the therapist must decide if, when and how much to self disclose on a case by case basis depending upon the needs of the client.

For some clients, any form of self disclosure or reminder that the therapist is affected is contraindicated because this reminder would be too overwhelming for the clients.  Even though, of course, they know, on some level, the therapist is affected, beyond knowing that the therapist is in good health and available to them, they don't want to be reminded that the therapist is experiencing the same crisis.

For instance, for some clients, who grew up with parents who were overwhelmed by one crisis after the next, these clients felt emotionally unprotected by their parents and had to fend for themselves as best as they could while feeling alone in their traumatic experiences.  They might even have had to function as parentified children to their parents where they took on the role of adults to take care of their parents--even though they were just children (see my article: The Roles of Children in Dysfunctional Families).

These clients often need to feel that the therapist can overcome any situation in order for the clients to feel safe in the therapy sessions.  This usually involves an idealized transference that the client develops for the therapist, which is an idealized view of the therapist (see my article: What is Transference in Psychotherapy?).

This is what undoes aloneness in the therapy session--the idea that, unlike the client's parent, the therapist is a competent adult who can handle any situation that comes up.

The resolution of the idealized transference will be determined by the client, and the therapist will take her cues from the client.  Over time, as the client's trauma begins to resolve and the client feels more empowered, s/he no longer needs to see the therapist as an idealized, powerful figure.

Converesely, other clients have a need to know that the therapist is also affected by a crisis that they're both experiencing, like the 9/11 World Trade Center attack or the current COVID-19 crisis.

For instance, during 9/11, many clients in New York City wanted to know if their therapist lost anyone at the World Trade Center.  Or, they wanted to know if their therapist experienced fear when the therapist heard about the attack.

Since both the therapist and client lived through 9/11, the therapist's willingness to discuss this as an experience that they each went through was often necessary and helpful. Obviously, the therapist needed to know each client very well to know what would be beneficial to help the client to feel less alone.

Another example is during the COVID-19 crisis a client might say that time feels distorted to her since the crisis began. In response, the therapist makes a clinical judgment as to whether it would be beneficial for the client to know that the therapist is having the same experience--with the same recognition, as mentioned before, that, although similar, each individual will have his or her own unique experience.

In addition, the therapist usually won't just end with self disclosure.  She would also talk about what the client can do to keep his or her perspective manageable.  So the therapist would provide the client with tools and techniques to accomplish this, so it's not just a shared experience but also an opportunity to learn how to manage emotions and maintain a perspective that's healthy for the client.

When the therapist self discloses, even if it's not a big self disclosure, it's always important for the therapist to metaprocess the experience with the client, which means asking the client what it was like to hear that the therapist was having a similar experience.  This helps to deepen the work and also helps the client to clarify the client's experience about the self disclosure.

In the event that the therapist made a clinical mistake in self disclosing, metaprocessing also provides an opportunity to repair that mistake (see my article: Ruptures and Repairs in Therapy).

Metaprocessing the experience of the therapist's self disclosure also helps the therapist to understand the client's experience.  This can lead to further explorations of the client's past, present and anticipated future.

The Therapist's Self Knowledge and Clinical Judgement About the Client
It's important for the therapist to know her own comfort level as well as knowing the client in order to make a clinical judgment call about self disclosure.

If the therapist knows that she tends to be reticent about self disclosure and that the client's question feels too personal for her, she needs to take this into consideration so that she's not uncomfortable with what she discloses.  At the same time, as mentioned earlier, she needs to know the individual client and what the client needs at any given time.  This is a balancing act.

At a particular point in time, a client might need to know something about the therapist's experience in order for the client not to feel alone in a situation.  However, over time, the client might have other thoughts and feelings about what s/he asked the therapist to self disclose.  All of this is grist for the mill and should be explored.

Undoing aloneness and self disclosure is an important and complicated topic, and one article isn't sufficient to address all the issues involved.  However, hopefully, this article gives you a sense of some important factors.

Getting Help in Therapy
As I've mentioned before, physical distancing doesn't mean that you can't connect in other ways to feel socially and emotionally connected.

If you're feeling overwhelmed, you could benefit from working with a licensed psychotherapist, who has the experience and skills to help you.

Rather than feeling alone and suffering on your own, you can get help from an experienced therapist.

Many therapists, like me, are offering online therapy while they're out of their office.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, Somatic Experiencing and AEDP therapist.  I also use EFT (Emotionally Focused Therapy) for couples.

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 or email me.

The Advantages of Online Therapy When You Can't Meet With Your Therapist in Person

Due to the contagious nature of COVID-19 and the mandate to stay home in New York City, I recently began conducting therapy sessions online to assure my clients' safety as well as my own. Online therapy is also called telemental health, telehealth, and virtual therapy, and I'm grateful to have the ability to connect with my clients and continue to do therapy with them.  I'm also glad that my clients can do therapy from the comfort of their own homes during this crisis (see my articles: Coping and Staying Calm During the COVID-19 Crisis and The Importance of Getting Emotional Support During a Crisis).

The Advantages of Online Therapy When You Can't Meet With Your Therapist In Person

Using Online Therapy During COVID-19 Crisis
Like many therapists in New York City, I began using online therapy as of last week so I could remain in contact with my clients.  Some clients prefer to have regular phone sessions, but others like having the ability to see me and feel more connected with me online than on the phone.

The online therapy service that I use is free to clients and they don't need to have the service to use it. They also don't need to have any special equipment.  They have a choice of getting the link either via text if they want to use their cellphone or by email if they want to use their computer. I just let them know that, before the session, I will send them a link for the meeting.  Then, I get a notice from the service when they're in the virtual "waiting room" and I "let them in" so we can begin our online session.

Aside from the convenience of doing online sessions, one of the things that has been interesting for me is seeing myself in real time in the corner of my screen while I'm doing therapy with clients.

In my regular in-person sessions in my office, I'm not looking at myself.  But with the online service, I can see my facial expressions and gestures when I glance up at myself occasionally, which has the advantage of making me more aware of how I'm coming across with the client.

This reminds me of when I was in training to be a therapist more than 20 years ago and one of my supervisors asked me to do audio recordings of my sessions.  This was done with the clients' permission.

Most clients had no problem with audio recordings and, in fact, they liked the idea that I would listen to these recordings after the sessions as a way to improve my clinical skills while I was in training.  It made clients feel cared about.

Although most clients were receptive to it, as a therapist in training back then, initially, I was self conscious about the audio recordings. But, after I few sessions, I liked listening to the recordings.  Similar to seeing myself online, I learned a lot back then from hearing myself when I played back the audio recording.

So, as technology evolves, it often provides therapists and clients with new tools and strategies for conducting therapy sessions.

Advantages of Doing Online Therapy
So far, these are the advantages I see with doing online therapy:

• Continuity of care for existing clients so that therapy sessions don't have to end because of the current crisis
• Convenience: 
• Fewer cancelled appointments due to work schedule or other appointments that would make it more difficult for the client to come in person to my office.
• Acessibility to people who have mobility problems or cannot come in person for another reason
• Accessibility for existing and new clients who can't meet in person due to the current Coronavirus outbreak
• Free to the client 
• Easy to use

Getting Help: Online Therapy
It could be a while before therapists and clients can return to in-person sessions in the therapist's office, so if you need help because you feel overwhelmed, rather than trying to cope on your own, you can contact a psychotherapist who is providing online therapy (see my article: Grieving Losses and Healing During a Crisis).

By working with a licensed psychotherapist online during this time, you can get the help that you need and overcome the obstacles that are keeping you from thriving in your life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.  

I use Emotionally Focused Therapy for Couples in couples sessions.

I am currently providing online therapy sessions for existing and new clients.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Helping the Helpers to Overcome Compassion Fatigue and Burnout

Compassion fatigue and burnout are real challenges in the helping professions, which include psychotherapists, counselors, pastoral counselors, doctors, nurses, physicians assistants, social workers, hospice workers, and other professionals that are part of the healthcare and helping professions (see my articles: Managing Your Stress: What Are the Telltale Signs of Workplace Burnout? and The Consequences of Workplace Burnout).

Helping the Helpers to Overcome Compassion Fatigue and Burnout

Many people in these professions are so devoted to their patients and clients that they put themselves last in terms of getting the emotional support that they need.  They often don't engage in the kinds of self care activities that would help to calm, soothe and help them to feel replenished (see my article:  Self Care: Is Self Care Selfish?).

Even before the current crisis, historically, helping professionals often neglected themselves to serve others.  While this might appear to be noble, these professionals often need more emotional support than most other professionals because they're often containing the anxiety and emotional needs of the people they're helping, and their burnout rate is high.

What is Compassion Fatigue?
Compassion fatigue is emotional and physical exhaustion for those in the helping professions who deal with their patients' problems.  When an individual experiences compassion fatigue, they often withdraw emotionally from their patients because they're too exhausted to continue.

What Are the Symptoms of Compassion Fatigue?
Helping professionals often don't recognize the signs of their own compassion fatigue or burnout because they're so busy taking care of their patients.

The following is a list of symptoms for compassion fatigue:

• Emotional exhaustion
• Physical exhaustion
• Insomnia 
• Irritability
• Anxiety
• Depression
• Apathy
• Depersonalization: A state in which one's thoughts and emotions feel unreal
• Feelings of shame and self contempt
• Feelings that they're being treated unfairly
• Poor job satisfaction
• Chronic aches and pains, including headache, backache and muscle tension

Fictional Clincial Vignette: Helping the Helpers With Compassion Fatigue and Burnout
The following fictional vignette illustrates some of the typical problems experienced by helping professionals with compassion fatigue and burn.  It also addresses how psychotherapy, including online therapy, can help:

Nan
From the time Nan woke up in the morning until the time she went to bed, she was on the go.

When she woke up in the morning, she had about 10 minutes to herself before she got her children off to school, made her husband, Tom, breakfast, and sat down to a quick cup of black coffee before she headed off to the hospital where she was a nurse.

By lunchtime, she was starving, but there was so much to do that she often didn't take a lunch.  During the time that would have been her lunch hour, Nan spent time doing what she loved best--talking to the patients and their families. This was the part of her job that she derived the most satisfaction from, and she knew that the only way she could engage with patients and their families was to talk to them on her lunch hour because there was no time during the rest of the day.

Later on in the afternoon, she would grab an energy bar or a muffin rather than sitting down to lunch.  Some of her colleagues who had been there longer warned her that she was going to burnout if she tried to keep up this fast pace without taking a break, but she ignored them.  She thought of herself as being much more devoted to her profession than these other nurses who took lunch and their 15 minute breaks.

She often got home late.  Her husband would help the children with their homework because he got home first.  He also cooked their dinner and often sat down alone to eat his dinner because Nan often worked overtime.

By the time she got home, Nan was often too exhausted to eat.  She would take a few bites of her food, and then she was off to bed to wake up early in the morning and start the same routine over again.

On the weekends, Nan and her husband were too busy tending to the children and doing chores to pay much attention to each other.  Her husband often complained that their sex life was practically nonexistent, but Nan was usually too tired to think about sex.  She brushed off her husband's concerns and told him that she had no choice but to continue working the way she had been doing.

Nan had always wanted to be a nurse.  Both her mother and grandmother were nurses.  Nan was proud of them and she wanted to be like them.

Before she started her training, she imagined that she would sit with patients and talk with them as well as administering to their medical needs.  However, once she was in the profession, she quickly realized that her job was so fast paced and demanding that she had no time to chat with patients.  She was under so much stress that, even though she was a diligent nurse, she often feared that she would give the wrong medication to a patient because she was often frantically busy on the hospital floor.

When Nan was in her fifth year of nursing, her health began to break down.  She was having backaches, not only from lifting patients but from holding onto stress and not practicing any stress management techniques.

She was also getting debilitating headaches, and her husband urged her to take a day off to rest and recuperate from her busy schedule. But Nan knew her hospital was understaffed with nurses, and she didn't want to let down her patients or colleagues.

By her sixth year, Nan was showing physical and emotional signs of compassion fatigue and burnout.  Although she used to love her job, now she was often irritable and snappy with her patients and colleagues.  One day, she even snapped at her supervisor, who brought Nan into her office and recommended that Nan take time off because she feared that Nan was burning out.

Although Nan knew that she was physically and emotionally exhausted, she didn't want to take time off.  She felt there was just too much to do, so she apologized to her supervisor and went back to work.  But when she snapped at a patient's mother, the mother complained to the administration and Nan was given a verbal warning by her supervisor that if this or anything else like it occurred again, Nan would be written up, and if it continued to occur, she would be brought up on disciplinary charges.

Nan was upset with herself.  She knew better than to get into a verbal altercation with a patient's family member, but she was so tired that she didn't have the patience to speak calmly to this demanding relative.

When she got home that night, she was confronted by Tom, who told her that he wanted to talk to her after the children went to bed.  She told him that she was too exhausted to talk or to even eat, she had a very stressful day, and she was going to bed.  But Tom was adamant that they had to talk, so she took a nap for an hour and then got up after the children were in bed.

Since Nan had chronic insomnia by now, her hourlong nap did little to alleviate her exhaustion.  She felt resentful that her husband was insisting that they had to talk.  She wished he would just allow her to sleep and they could find time to talk in the morning.  But Nan also knew that there would be nothing different about the morning--she wouldn't have time to talk because she would be rushing around the house and, at the same time, trying to get ready to go to work.

So, wearily, she sat next to her husband on the couch and waited for him to begin talking. As she looked at him, she noticed his face looked strained.  Then, he looked like he was about to cry and  she got anxious, "Oh God.  What's wrong? Are you alright?"

"Nan," he began talking slowly, "I don't think I can take much more of this. We haven't been intimate in months.  We barely have time to talk. I don't want to leave you and the kids, but I'm so unhappy. Something needs to change."

Nan was shocked.  She felt her stomach lurch and the pain in her back intensified.  For a few seconds, she didn't know what to say, so Tom continued, "I want you to take time off.  You have so much sick and vacation time.  Let's plan a vacation just for the two of us.  We haven't gone away in years.  We'll leave the kids with my mother.  What do you say?"

Nan's first inclination was to say she didn't have time, but she knew now that Tom was seriously unhappy, and she didn't want him to leave.  After a few more seconds, she put her head back and closed her eyes.  Then, she could feel the tears coming and she couldn't hold back any more.

A few minutes later, Nan agreed that she couldn't keep up the pace and she knew she needed to take a break.  She knew her supervisor would be thrilled if she took time off from work, so she told Tom that he should pick out a destination and she would go.

Two weeks later, Nan and Tom were in Puerto Rico.  Although, initially, Nan felt uncomfortable and restless, by the third day, she was feeling more relaxed than she had felt in years and enoying her time off with Tom.  They rekindled their love life and enjoyed each other's company for the first time in a long time.  They also made a commitment to each other to go on vacation at least once a year.

By the time Nan got back, the first cases of COVID-19 began to pop up in New York City. Within a short period of time, she and her colleagues were inundated with Coronavirus cases, and Nan felt like she had never gone on vacation.

She felt herself becoming irritable and snappy again, and her supervisor saw the warning signs.  She recommended that Nan seek help through online therapy to deal with her emotional and physical exhaustion.  She also insisted, despite the shortages of nurses, that Nan stop working so many extra hours of overtime.

At first, Nan resisted the idea of online therapy because neither she nor anyone in her family had ever been to therapy before, and she resented being told to go.  But she also knew that both her marriage and her job were on the line, so she made an appointment for once a week online therapy, and after a couple of weeks, she was glad that she did.

Not only did she feel less physical and emotional strain, but she felt she was coping much better than most of her colleagues. She could feel that her therapist understood her and cared about her.  Her online therapist scheduled an appointment that was convenient for her and she could talk to the therapist from the privacy of her bedroom while Tom kept the children entertained.

Nan noticed that she was no longer having backaches and headaches.  She also learned to switch her attention to her husband and children once she got home rather than ruminating about work like she usually did.

Her therapist helped Nan to develop a self care routine, which Nan never had before.  She also taught Nan meditation and breathing techniques that she could use on her own (see my articles: Breathwork to Cope With Stress: The Square Breathing Technique and Learning to Relax: Going on an Internal Retreat).

Even though Nan was going through a stressful time at the hospital, she no longer felt burnt out.  In the evenings and weekends, she took time for herself first before she spent time with her husband and children, and this made her time with her husband and children more enjoyable.

Throughout the crisis, Nan continued to attend her online therapy sessions, and both she and her therapist agreed that once the crisis was over, she would make time to come into her therapist's office to do in-person therapy.  Her only regret was that she hadn't started online therapy earlier.

Conclusion
Compassion fatigue and burnout are real problems among helping professionals.

Often other people, like a supervisor or spouse, notice the problems first because the helping professional is usually dedicated and immersed in work.

Online therapy sessions are an alternative for helping professionals who are working long shifts and doing stressful work.  They are both convenient and an effective way to provide mental health services to busy professionals.

Getting Help in Therapy
Anyone can experience stress, burnout or compassion fatigue, including caregivers to children and elderly relatives (see my article: Self Care For Caregivers).

If you feel emotionally overwhelmed, contact a licensed psychotherapist who is providing telementalhealth services, rather than getting physically and emotionally exhausted.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples and provide online therapy sessions during the COVID-19 crisis.

I provide Emotionally Focused Therapy (EFT) for couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.