Phases of Coping with the Pandemic By Marit Appeldoorn, MSW on 6/9/20 - 1:01 PM

As we know, the COVID-19 pandemic presents unique challenges to both the client and the therapist. This phased framework for coping with the pandemic was developed by integrating my observations of patterns in client responses with application of developmental and resilience theories and research on the neurobiology of trauma. The framework helped in working with Melissa, a 42-year-old client and single mother of two preteen children.

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These phases are presented here in a neat and clean linear fashion, but, the pandemic is anything but! Our clients move in and out of phases based on new and changing information and the complex emotional reactions they must process in response to these changes. Being at an ‘earlier’ phase is not failure. It is simply fact, and we can help clients acknowledge that with awareness and give them the care and support that fits the phase they are in.

Phase I: Shock, which might include a freeze response. In my office in mid-March, we discussed social restrictions and my move to telehealth. She said, “I feel numb… kind of in a daze, like this isn’t real, and I keep forgetting what I’m doing mid-task.” I immediately shifted into somatic based interventions focused on regulation and grounding. I had her feet firmly on the floor, did a ‘sensory count’ orienting exercise looking around the office, and I handed her a weighted blanket to place on her lap.

Phase II: Crisis, when shock wears off and people might move into a ‘fight or flight’ response. Clients sometimes feel enraged, terrified or are in a ‘‘hyper alert’ state of vigilance. When Melissa and I connected for our first telehealth session, she spent several minutes angrily pointing out all the “ways in which no one is handling this.” She told me she was sleeping poorly and found herself scrolling through her phone for hours each day reading news articles and posting on social media. I offered support and reminded her anger and fear were normal responses to an out-of-control situation. We identified boundaries she could set for herself and ways in which she could mentally “take a break” from her pandemic worries and discharge built-up cortisol and adrenaline.

Phase III: Coping, when our resources are marshaled to determine “how we are just gonna get through until this is over.” In coping, people are living and working in ways which significantly overextend them. During the next few weeks as Melissa adjusted to life ‘on lockdown’, she put in long hours trying to make sure her children met every single expectation of their school’s distance learning program. She would then stay up late trying to finish work for her own job in the insurance industry, and frequently would find herself overeating or having “more wine than usual” as a way to numb out the exhaustion she felt. During this time, we addressed Melissa’s feelings of guilt and inadequacy as she tried to “do it all” and found online resources for her to support her children’s learning, and I encouraged her to honestly evaluate how long she felt she could sustain this routine.

Phase IV: Adaptation, which shifts out of coping into an awareness that life changes should be viewed as sustainable and semi-permanent. The focus also slowly moves away from replicating or waiting for pre-pandemic life to return. Clients are able to evaluate, reflect and ask themselves, “What’s working right now?” Melissa began examining, as she put it, “the question of how I want our lives to be for the foreseeable future.” Although she at times moves back into crisis or coping based on current events or new stressors, her sessions now consisted of my supporting her to make decisions which had the goal of balance and sustainability. She adjusted her expectations for online learning, spoke to her supervisor about a temporary reduction in her caseload, started making more time for Zoom calls with friends and recently declared two hours every afternoon as “chill out time” for her and her children to relax, take walks, nap and play together.

It is difficult to be in adaptation without a sense of basic economic security, physical safety and human connection. Melissa had a basic foundation of these experiences which helped her move into adaptation, but the deep systemic inequalities in our country mean many clients will be pushed into the chronic crisis or coping phase. Regardless of what phase they are in, using this framework helped Melissa and I to work together, providing both support and understanding.  

File under: The Art of Psychotherapy, COVID-19 Blogs