Tonight I am due to meet with my clients face-to-face. I have talked to them about how we manage the possible consequences of coronavirus and feel confident about the practicalities of managing an unplanned break or how to deal with either party needing to self-isolate over a period of time.

I am able to offer on-line alternatives and have been working through the implications of a possible change for clients who I usually work with face to face which we will discuss when we meet today. All this feels in hand.

However, as I reflect on the challenge of maintaining a sound ethical framework and being able to manage and contain an unknown range of uncertainties in order to offer the best possible service to my clients, I am aware of another less defined challenge.

As therapists we commit to working from the client’s frame of reference whatever our modality. In training and in supervision we work hard to understand how to become aware of and make therapeutic use of our own responses to our clients. This is a life-long commitment and different approaches have different ways of understanding this use of self. For me there are the long-standing triggers from my own life history and experience which I am alert to and familiar with. There are also the unexpected responses to clients which form the basis of much of ongoing supervision work, but it feels like there is something qualitatively different about this coronavirus situation.

Fear and anxiety about the unknown

I lie awake listening to the news. I don’t know if my measured internal response is a symptom of denial or calm common sense. Occasionally, especially after hearing the mounting numbers infected and associated deaths my mind dares to imagine an apocalyptic situation where many people are really ill, resources scarce and the health service unable to cope. I think of my partner who has serious underlying health issues and other family members scattered throughout the country. I imagine being the cause of introducing the virus into my family or infecting a family member and inevitably I feel a spike of fear and anxiety about the unknown and what this means for the world.

How will this impact on my work? Can I truly facilitate my client to explore their fears and anxiety about what might happen when I have unprocessed fears myself? Unlike specific client issues which come into the therapy room this affects all of us. Surely my supervisor is going through the same process as me? As a supervisor myself this holds true. Can we all truly hold and support clients when our own existential place in the world is also in question? How can I hold the boundary of self and other in a therapeutic way when these boundaries are necessarily blurred?

All of us are affected

Another challenge is to remain vigilant about inadvertently ‘joining’ the client in the speculation about what will happen. It feels like a strong pull which sometime happens when my own world and that of the client’s appears to elide. But this situation is qualitatively different because all our worlds are actually eliding. This is not an issue which I can simply identify and work through either in my own therapy or in supervision, because this time all of us are affected. Is it even realistic to try and hold a line?

In order to be therapeutically useful and available I place a high value on congruence, but this may be difficult if the client says something which ignites fear in me. As I think about tonight I am aware of the pressure of wanting to process this before being caught unawares in the moment. As I realise this, I realise that I have found a hillock of firm ground. I can own that this touches all of us including me and then turn my attention to what my client needs. This is no guarantee of how to manage but it gives me a sense of being able to respond and remain open without denying my own humanity.

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