Working with Trauma During the COVID-19 Pandemic By Jacqueline Simon Gunn on 3/19/20 - 12:30 PM

I walked into the grocery store Sunday morning after a relaxing run. As soon as I came in the doors, I saw the headline of the newspaper in bold letters reporting that New York was in a state of emergency. Anxiety coursed through me. Earlier that same morning, I’d had a phone session with a patient who was becoming increasingly anxious due to news of the spread of COVID-19. She was starting to feel like she couldn’t leave the house.

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New York City has been empty, comparably speaking. In a somewhat eerily quiet Midtown — where the crowd can make brisk walking a challenge — on Tuesday afternoon, I couldn’t help but be reminded of the days following 9/11, where in place of the vitality and determination that usually fills the streets of Manhattan, there was tense anticipation, like a cloud hanging over the city, just waiting for rain to pour down. And in both cases, no one had an umbrella to protect them, not even psychotherapists.

We are the ones who are to be containing anxieties, speaking to people about their fears, the trauma, not feeling protected. We’re supposed to comfort and soothe and help people use whatever resources they have to cope.

I have worked with trauma patients ranging from rape to incest to emotional abuse to people suffering after 9/11. I’ve worked in the prison system with perpetrators who were also victims. I’ve listened to stories that were utterly terrifying, heartbreaking, even some so bad they seemed unbelievable. Most of us know these stories and most of us know how to listen and allow difficult emotions into the room. We know how to contain them, which helps patients feel comforted.

A supervisee many years ago, working with her first incest survivor, asked me how she could empathize with something that was so foreign to her. I suspected that the content made her uncomfortable. Stories of incest can be very painful to hear and it’s natural that we have feelings about them whether we know the experience personally or not. Empathy, we had discussed, comes not necessarily from identifying with circumstances, but more so from relating, understanding and being with the patient in the difficult emotions associated with the traumatic experience.

We’ve all left sessions and been deeply affected by patients’ stories, their emotions, their experiences. But most of the time, we can separate their distress from our own personal lives.

But how do we as clinicians do this when we are immersed in the same traumatic environment?

Trauma is anything that fractures our sense of safety. What if our sense of safety is also compromised? When we are also inundated with information that traumatizes us, how do we help others?

It is important to be informed and updated, but the way the information about COVID-19 is being presented on some media outlets, and the amount of it, is creating an environment of hysteria, one we need to be able to step out of in order to provide effective care.
People are more likely to be pinned to the news when they feel unsafe, because it gives the illusion of control over an unsafe environment. But at the same time, the flood of news causes more trauma; so, the reaction to feeling traumatized is to look for comfort by reading information that’s being presented in a way that is more traumatizing. It’s so insidious, most people don’t even realize what’s happening to them or that there are things they can do to minimize the emotional impact.

In this way, it is a type of micro-trauma — small, subtle, consistent tears that break down our psychological resilience and resources, causing depression and anxiety, as well as psychosomatic symptoms.

So, what do we do to help?

The hard truth is that we were never safe to begin with. Our environment is always precarious. Of course, worldwide devastating events make us more aware of this, but it’s always there to some degree: anything can happen and everything can change — in an instant. I think as clinicians most of us know this. Most of us have found ways to accept this reality and to cope with it. Under normal everyday circumstances, the use of some denial is adaptive.

I find myself returning to this truth as I try my best not to be caught in the frantic energy naturally evoked when a state of emergency or pandemic is being announced everywhere and news that’s meant to inform the public is terrifying people. The headlines that capture attention, like NEW YORK IS IN A STATE OF EMERGENCY, are traumatizing people.

Reputable sources post their information more quietly. If you go to the CDC website, the information is written in calm, clear language, and is not meant to alarm people or cause hysteria. It’s meant to inform.

What we can do is to help people see where they do have control. The CDC advises us to practice good hygiene, to wash our hands, cover our mouths when we sneeze or cough with a tissue, practice social distance, be vigilant. These are things we can do. These are ways that we DO have control. Worrying is not going to change anything. But we can change our behavior in a way that is helpful.

When there is a global trauma such as this, our powerlessness over circumstances is highlighted to such a degree that healthy denial breaks down. We must help our patients focus more on areas they can control. Show them that they do have power over some things. There are things they can do. We must contain and redirect.

Additionally, we will be more equipped, emotionally, to handle whatever is presented by our patients if we decrease the amount of time we spend consumed by information that’s just making us feel more helpless. Being aware that too much news is a maladaptive attempt to cope with an unsafe environment is part of our role as mental health professionals. We so often talk about self-care being important. In this case, not drowning in news is part of this practice. We can’t change what’s happening, but we can adjust how we respond so that we can help others do the same.

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