How COVID-19 Changed my Counselling Practice

The pandemic has not spared anyone. It has impacted each and every one of us, all over the world, creating uncertainties and new situations that we were not prepared to deal with. Nonetheless, despite these worries and challenges, along the way we have come up with new ways to handle the crisis, and also new ways of living – here in Malaysia, we’ve had new SOPs (standard operating procedures) to adhere to, we’ve locked down our country’s borders, we’ve had MCOs (movement control orders) as well as RMCOs (Recovery Movement Control Orders), all to unite us as a nation and to better manage the impact of the pandemic.

One thing’s for sure, as a therapist I have also taken a blow. Managing the impact of the various stages of the pandemic has given rise to various challenges. I have undergone a steep learning curve as a therapist – I had to step away from the traditional face-to-face session that I was accustomed to. Building rapport and trust are so much easier in a face-to-face session, as is the use of certain counselling practices e.g. the sand tray, EMDR (eye movement desensitization and reprocessing), as well as hypnosis. However, the reality of the pandemic, as well as the importance of safety, set in and we were forced to adapt and change. Throughout this process of adaptation, I had a lot of questions: can I continue working? Will my practice be impacted? Will I still have to pay rent for my counselling space? I had a lot weighing on my mind, and I am now so glad that I was able to work through it.

During the earlier stages of the pandemic, everything was so uncertain, almost all counselling was put on hold, there were MCOs, lockdowns, adding to serious concerns in terms of my personal safety from the virus as well as regarding high-risk members of my family. I had to ensure my personal safety in order to ensure the safety of my love ones, which meant that even when face-to-face sessions were possible, I was not able to offer them. So, with plenty of time on my hands, I decided to go with the flow and I discovered that many online courses were being provided for free, and others which would normally be unavailable online now were because of the pandemic. During the early months of the crisis, I did more studying online than I had done in my whole career as a therapist.

Support groups and free advice services for therapists also mushroomed during this period, especially in our local arena (Malaysia). We saw personal initiatives taken by senior practitioners as individuals and as organizations to give free telephone support on handling the repercussions of the pandemic. I finally managed to create my own support group with a group of peers that share the same vision and values, as well as joining two other support groups. One group focuses on learning for new therapists and the other group is led by a senior clinical psychologist who is trained in CBT, and who also implements mindfulness into her work and into her everyday life. This support group was set up with the aim of incorporating mindfulness into our lives, as well as our counselling practice. The group also offers free case supervision. This was the support network I had been searching for. I had been working as a self-employed counsellor/therapist for a long time, and during the pandemic, I was finally able to join these groups, and the industry offered strength and support to therapists, as well as the community. In fact, many initiatives are still in place today.

During this pandemic, many free helplines were set up by organization such as NGOs here in Malaysia, more than ever before. The main helpline was set up by the Malaysia Counselling Board (Talian Kasih), which is run by volunteer counsellors under the counselling board. This is a 24-hour service that handles distress calls on account of the challenging lifestyle changes that the pandemic has caused. I chose to volunteer at Buddy Bear, which is the only helpline dedicated to helping children here in Malaysia, and that offers Psychological First Aid to distressed children (under 18) who were born during the MCO period. This helpline aims to provide a safe space for children to talk about their worries and their concerns during the COVID-19 pandemic. The Buddy Bear Childline Findings from the Malaysia National Health and the Morbidity Survey 2019 showed that about 424,000 or 30% of children are living with some form of mental distress.

Working for this child helpline has enabled me to grow and to learn more since we had to obtain certifications for Psychological First Aid, and we also completed various training courses by various NGOs that deal with children to ensure we were ready to handle the helpline. Therefore, as a member of my community, I feel privileged to be able to volunteer for this helpline and to help those in need, in this case, distressed children during a world-scale pandemic. As part of the preparation for our role, we were required to attend various training courses on Psychological First Aid, as well as relevant training courses to prepare us for handling young callers. I was only able to commit as a volunteer for taking calls, so I was taken aback by the passion and commitment by the committee members who work around the clock to prepare the training modules, handle publicity, offer ongoing support to volunteers etc. to ensure everyone is prepared to handle a call. Joining the helpline was a real eye-opener, as I realized that so much background work is done to ensure the childline is able to reach its target audience, that the volunteers are trained, and that sufficient safety protocol is in place to make sure that volunteers do not have previous criminal records related to children, such as charges of paedophilia or of sexual grooming. This was all an immense learning curve for me.

During the beginning stages of the pandemic, my practice also shifted to tele-based psychological support. Initially, I was uncomfortable with this change and I would think: “I miss the face-to-face interaction with my client”, “just practising online feels different”, “what should I do about the rent that I still have to pay for my office space?”. All of these thoughts running through my head, the uncertainties, worries and insecurities that they created, are a testament to the fact that we are all human, we’re all flawed, but we have to keep moving forward the best we can. Or, to quote a saying I always go by, “go with the flow” - it will take you right to where you are supposed to be. So, here I am going with the flow, learning how to use web-based platforms, HIPAA compliance platforms etc. all amidst a few technical glitches encountered along the way. There is also the issue of misinterpreting cues from clients (especially when I can’t see my client’s face very well, when the client has not properly set up their camera, or with clients who prefer not to use the webcam at all). Because of this, it may be a while before I realize that the client may be uncomfortable. I have had to handle this, just as I usually would in a face-to-face session, but with a different approach. And this is coming from someone who is not at all tech-savvy and is still struggling to set up her own Instagram profile…

Humans are creatures of habit, and once we have had the time to pick up new habits we will feel good and comfortable about them. Though initially, we see people struggle with new habits (as was the case with the uncertainties of working from home, lockdown, wearing face masks, new standards of hygiene etc.), these new ways of life will soon be integrated into our daily routine. In fact, some of my clients or friends, even myself, have found that we are quite happy to work from home and that it is actually possible to work from home, study from home. Some clients have even taken the experience further and with the help of modern technology, they have discovered new hobbies and learning opportunities.

Nevertheless, there are also plenty of people who have experienced feelings of suffocation, isolation, and distress during the lockdown period, and who are really struggling. I guess that I am one of the lucky ones who have found that I enjoy working from home, juggling home and work life, as well as learning new ways of offering tele-based psychological support. As with all things, there are definitely both pros and cons, so I believe we need to establish our own routines of self-care, as well as maintaining certain levels of personal space. During the earlier stages of lockdown, I really missed having my own personal workspace, something which I had taken for granted prior to the lockdown. Now that I am settling into my new working and life routine, I am also learning to better manage self-care, and this included setting up my own personal workspace.

On top of learning that we can in fact effectively offer psychological support online, I am mindful of assessing client stability and safety, and in cases where a client’s mental health is not stable I will usually refer them for further psychiatric treatment if required or refer them to fellow peers who handle face-to-face counselling sessions. The pandemic has greatly impacted our wellbeing and our mental health, and for some clients, emotional distress may be due to external factors that the pandemic has exacerbated. Thus, as a therapist, in whatever method we are using, client safety and wellbeing must always come first. We need to take stock of both the benefits and the limitations of working online, with client safety at the forefront of our work.

This is all working well for the moment, at least for me. In fact, I was amazed when I discovered that EMDR (eye movement desensitization and reprocessing) can be done virtually after an EMDR practitioner shared their success as well as the EMDR safety protocol online. Even when going back to face-to-face sessions, this will change how I practice EMDR, now that I know that clients can actually be trained to use sets of bilateral stimulations such as taps by themselves. This was something that I never expected prior to the pandemic; I had always look at EMDR as a treatment that needed to be completed in person. In the aftermath of the pandemic, I have come to realize that with some modifications this technique can be done online, though of course only after assessing my client’s stability and safety.

Though I miss my workplace tremendously and having my sand tray, my therapy cards etc. on hand, I have learned to used other tools, such as artwork to help clients express and explore their feelings. This is made even more effective with modern technology: sessions from a client’s laptop, file sharing, drawing via WhatsApp, being able to have discussions with both the client and myself having a copy of the drawing or writing at the end of the session. I have also learned to implement mindfulness into some parts of my practice, to ensure clients are relaxed after an intense session. With a laptop, I am able to simply play short videos or recordings on mindfulness, which work wonders and serve as a take-home coping exercise for the client on finding relaxation and stability. All of these aspects are pretty remarkable, seeing as prior to this mindfulness and art would not have been one of the tools that I would use in therapy. With the shift to virtual sessions, I have learned to adapt, be more creative, use tools that are suitable for online sessions, and learn more about new techniques like mindfulness, which I continue to learn about alongside my client. I have also found that certain clients who struggle with new environments get much more enjoyment out of sessions that are from the comfort and safety of their own home.

Prior to the pandemic, a huge part of my work had been providing face-to-face sessions. Now, I divide my time between tele-based psychological support, webinars, enjoying online courses that were previously only available face to face and based overseas, support groups and voluntary work with the Buddy Bear child helpline. I suppose that as a therapist, the pandemic has created a lot of opportunities for myself to learn and grow in my profession. From using technology that was previously limited only to Skype and WhatsApp, now I have actually learned about other web-based platforms that can be used for therapy sessions as well as webinars, such as Zoom, Microsoft Teams, Citrix, Webex, Doxy, and so many others that I am yet to learn about. I guess this is a part of being in a helping profession: you see that learning is a lifelong thing – the more you learn, the more you realize what you have yet to learn.

Of course, I still miss my counselling centre and my face-to-face sessions, and I am looking forward to experiencing these things again. However, virtual sessions are certainly something that are here to stay, and which have pushed me to learn different ways we can do therapy, just as the crisis has pushed everyone to explore modern technologies to make remote working possible. This how we work through our life’s uncertainties: go with the flow and trust the process. As the saying goes, we might be in the same storm but not everyone is in the same boat. The scale of the pandemic has varied across the globe, as well as how it was managed and how much it has impacted us. Stay safe everyone.

Ann Ding Choong Ai is a counsellor and hypnotherapist based in Kuala Lumpur Malaysia who works with individual clients on the various life struggles and challenges that they may face.