As the toll of the pandemic continues on, therapists are seeing the effects becoming more and more present in their sessions. One issue that is being discussed regularly in recent months in our peer consultation groups is difficultly managing emotional regulation by the therapist. 

As therapists, we are used to compartmentalizing our lives during our sessions to keep the focus on the client and how to best serve them.

Many of us have experienced a time when something going on in our personal life would at times intrude into our thoughts during sessions.

Since the onset of the pandemic, more and more therapists are struggling to stay emotionally regulated during their clinical work.

I was horrified a few months ago when I found myself being questioned by a client about the vaccination status of our family before the upcoming holidays. Instead of exploring why they were asking, deflecting or using another therapeutic technique, I found myself feeling defensive and activated due to the way this issue was playing out in our family.

I have been practicing a loooong time and had not had that experience in many, many years.

When processing it later, I felt shame, concern for the therapeutic relationship and disappointment in myself.

Here’s the thing though, it is happening to a lot of us right now! 

For example, therapists with anxiety are reporting increasing symptoms before and during sessions as their clients discuss the very issues the therapist is also experiencing.

So what is a therapist to do when encountering this in their work?

• Take a moment to center yourself and decide how the session should continue…addressing it, moving on or something else.
• Be kind to yourself after the session. You are not the only one experiencing this.
• Remember that we are hyperaware of our function during interactions with clients but what feels huge to us may not even be of note to the client.
• Get peer support!!!! Now is a great time to reach out to your colleagues, consultation group or therapist besties for support.
• Remember that even on our worst days, we are likely showing up for our clients in a beneficial way. Have you ever revisited something from the previous session with a client that felt concerning to you but they were unaware or unfazed by what happened?
• Assess if this is a one-off happening or if it is occurring more often. This will guide your next steps.
  
  • Maybe you need to schedule your day with more time between sessions
  • distribute your sessions differently throughout the week
  • or if it’s an option, take some time off.
  • Canceling even just one or two clients during any given week can provide some much needed respite without a complete loss of income. (And yes, I did not there! Deciding to cancel a session factors in the needs of our client but in private practice, it also should factor in our finances and well-being, and it’s OK to name this. You are still a caring professional.)

• Plan ahead. Before sessions, take time to check in with yourself and think about the client you are about to see. Are there topics or reactions that could be activating to you based on what you know about them? If you are virtual, do you need a sticky note on your monitor to remind you to breathe? Do you need to allow for additional self-care or time to yourself after the session?
• Go wash your hands after the session. Focus on the warm water and foam of the soap on your skin. Take deep breaths, relax your shoulders and jaw, pull your tongue off the roof of your mouth, and rotate your head from side to side. Don’t forget to keep your favorite lotion nearby to apply for further comfort.
• Talk to your own therapist to get help establishing a plan to address the increased feelings, reactions or burnout you are experiencing.
• If you are a newer clinician, please understand this is not a typical scenario in our field. There are many overwhelmed newbies as well as seasoned therapists out there questioning if they can do this work. I will address this more in a future email.

As much as we don’t like to think about it, 

therapists are humans and our own needs have to be a part of the equation of our client work.

Long gone are the days when the sole focus is on what is best for the client. Sure, they are and should be our main focus but if we are compromised in any way, there is the potential for harm instead of good.

And as I have been saying for about a year now, we are looking for OK right now in terms of how people are doing. We need to lower the bar on what we are capable of as we approach 2 years of pandemic living.

None of us knows what our new normal will eventually be but the reality is that getting mental healthcare is becoming more widespread and normalized. While this has been a blessing for those of us working with populations of people who have previously never considered accessing therapy, it also means more clients are seeking services without more therapists to provide it.