Practising Through the Pandemic: An Attachment Therapist Reflects
A shared trauma, a crash-course in remote working, and a reminder of our human ability to adapt, be creative and connect… Attachment-based relational psychotherapist and trauma specialist Gülcan Sutton Purser looks back on nine months of clinical practice quite unlike any other.
I have worked online before, and do so regularly with supervisees who live far away. But I had never before worked solely online with all my clients, and hardly ever with somebody I had never met.
This wasn’t happening under normal circumstances, either. The threat of coronavirus was hanging over us like an axe waiting to drop. I had to be available for my clients, yet I was scared too. I was in the trauma just as they were. It was a situation that was sudden, uncertain, and in which we lost choices. So the fear response was strong.
At first, there needed to be crisis management. Clients were in survival mode. Their basic needs became priority, and the therapy became more directive. Interventions needed to focus on their containment, bringing in psychoeducation, encouraging social support and practical skills training, including relaxation and self-care, and management of anxiety and fear. I needed to calm and regulate my emotionally overwhelmed clients, helping them to release the tension. I needed to help clients to get in touch with their resilience and explore what they could do to feel more agency. I did reality testing with clients who were either minimising or maximising the situation.
Understanding our autonomic nervous system helps. When frightened, we go into fight, flight, or freeze response. Grounding, being in the body and slowing down were important.
Clients’ responses to online work and the lockdown were varied. While lockdown brought states of isolation for some, or sudden intensified intimacy for others – too much space or loss of space – most were grateful for continuity in their therapy. I found it important to be able to offer different ways of engaging: zoom, skype, phone, for back-up and because each client might need a different way of engaging. Some need to see my face. Others prefer phone, which may give the internal experience more focus, or hide them more. I came to realise more and more that therapeutic space and the therapeutic frame are key factors for online work. There have to be similar preparations as if we are working face to face.
With online work, more vigilance is needed. Social distancing is so contrary to our nature. We co-regulate, we are social animals. Self-regulation comes from co-regulation – and how hard, for those clients who didn’t have that early on, to find it within them now. Online, I found myself co-regulating my clients using more responsive sounds, longer exhalations, and self-grounding.
A colleague suggests that her clients use a method called Autonomous Sensory Meridian Response (ASMR), which can produce a flow-like mental state. Curious, I checked to see why it is popular, and discovered that it is similar to attachment work – the soothing voice, the personal care, creating a sensate focus, therefore helping with regulation.
It took six weeks for the crisis to become a new norm. We are creative and adaptive beings. Beforehand, I feared that my clients wouldn’t find online working satisfactory, and they would stop. Months on, they are carrying on regardless. I have realised that I needed to relax into remote working, rather than being rigid about its value. It gave the client a message of, “we are carrying on connecting no matter what the circumstances may be”.
It’s as if we have found flexibility in the rigidity of lockdown. After all, it’s the relationship that matters. As my ex-analyst would have said wisely, “you can even work from a broom cupboard…”