I recently asked a highly respected psychotherapist and colleague, Martin Limb to share some of his reflections on the Covid-19 lockdown. Martin has an active psychotherapy practice with a range of clients that include young adults and children with disabilities. This post consists of an edited version of Martin’s article. The piece reflects on how we use stories for sense-making and the importance of the words we use when we think about the events of our lives. He also offers some excellent advice, based on sound research, on how we can re-frame the narratives of danger, fear and anxiety so prevalent in the media into stories of hope, creativity and coping.
Martin is a UKCP Registered Psychotherapist who works with both adults and children. He worked for many years in the NHS as a speech and language therapist, specializing in communication difficulties in adults and children with learning disabilities. Currently he has an independent psychotherapy practice (meetingyoungminds.co.uk), as well as lecturing on mental health to student speech and language therapists at Essex University, and teaching on a BACP approved counselling course. Martin also serves on the Ethics Committee of the Child College at UKCP and on a working party updating current standards of practice for psychotherapists working with children.
I thought I’d write mentioning some specific concepts that I have found useful working with clients, (both children and adults), who have presented with a variety of difficulties; they are also readily applicable to our current situation.
Covid-19: A unique experience.
The Covid-19 crisis is a unique experience for all of us. That, in fact, is one of the major issues: Most of us don’t really have anything in our experience to compare it with or make sense of it. We only have what we have heard or read about.
We are aware that pandemics have occurred in the past. But one in which a significant part of the planet is ‘locked down’, is not something our minds can readily get to grips with. So, how do we make sense of it?
A pandemic in which a significant part of the planet is ‘locked down’, is not something our minds can readily get to grips with.
Here are some of the concepts I think are relevant to consider:
The words we use.
As a therapist, I’m always very interested in the words we use to talk to ourselves, and others about things. They can be helpful, or unhelpful. And look at the words and phrases we keep hearing: Words like ‘lockdown’; ‘enforce’; ‘time of uncertainty’; ‘distancing’; ‘no exit yet’.
What do they remind us of from our own experiences, or what we’ve read or heard of others’ experiences? Nothing very pleasant! They have strong connotative meanings.
Connotation refers to an implied meaning, different from the thing which it describes explicitly. Words have both cultural and emotional associations or meanings as well as literal ones—the literal meaning refers to what they specifically denote: A chair is a chair, (generally), a lockdown has associations of prison; control being taken away, and so on.
Connotations help us to process or make sense of our experiences. And when those experiences are particularly difficult to fathom, we might struggle. To deal with these experiences, we may need to re-frame them. Reframing refers to changing the connotative meanings we associate with our experiences.
I am reminded of something a colleague of mine expressed to me. David Corr, a psychotherapist who specializes in working with trauma, pointed out that trauma is anything happening in the here and now that reaches us through any or all of our five senses, and which triggers unpleasant memories for us.
David is thinking not of single major life-threatening events, but of the seemingly small things which happen regularly and which are hurtful, shame-inducing, frightening or anxiety provoking. We don’t even have to be consciously aware of what the memory is. It can be a ‘locked down’ or suppressed memory. And we may not be aware of the exact emotion triggered; only that we feel bad about it.
David quotes from a work by Dr Peter Levine:
‘’Trauma is trauma, no matter what caused it. Trauma occurs when an event creates an unresolved impact on an organism.” (Levine, 1997 p.12).
Trauma occurs in situations where we are powerless to change anything, so the memory gets distorted.
David also mentions a personal example: How falling through the ice of a frozen lake in Canada and narrowly escaping with his life, had very little impact on him compared to some “relatively little” experiences in his everyday life. Why? Because his brain was able to integrate the ice incident into his life story, but the other experiences were much more difficult to make sense of.
Trauma occurs in situations where we are powerless to change anything, so the memory gets distorted. It becomes “literal”, encoding current sensory and other cues: sights, sounds, scents, or sudden thoughts. And later, when the memory is triggered by any of these cues, it can cause flashbacks to the traumatic occurrence with all their associated feelings, as if we are right back where it originally happened. The difficulty comes in because trauma memories do not carry with them their original contexts, so we have no frame of reference that can help us tell ourselves, “but that was then, this is now.’’
The lesson I take from the trauma concept is that when we don’t understand something and have nothing to compare it with, it becomes much scarier. And with Covid-19, we are faced not just with such a sudden major event, but a whole host of other experiences that accompany it and which we are likely to find hard to integrate in our minds.
The lesson I take from the trauma concept is that when we don’t understand something and have nothing to compare it with, it becomes much scarier.
Examples include loss of income, loss of routine, loss of contact with friends, uncertainly, living with others in a different way, losing control over many of our day to day life choices, and so on.
This has a predictable impact on our brain chemicals: As anxiety increases, so the balance of our fight-flight (stress) system gradually tips towards a state of over-arousal; we become what psychologists call, hypervigilant. Our bodies respond as if we are in danger, even though we may not be. A good example: A friend told me only yesterday about how she wasn’t enjoying walks out as she was constantly on the alert (‘hypervigilant’) for people who might ignore the social distancing rules. In the end she cut it short and went home.
Neuroscientists have uncovered another piece of evidence about how the brain works that amounts to good news in the context of trauma. The brain has plasticity: the ability for nerve cells to change and new pathways to form through having new experiences and developing new ways of thinking about things.
So my friend who became hypervigilant while out on her walks, was able to reframe her experience when out and about. She successfully thought of the number of skills she had in observation and thinking ahead. She is a keen hillwalker and lover of wild places and knows her way around nature. These were skills she already had and which she was able to utilise in helping her think about her walks out in new ways. This helped her find a new way of paying attention – shifting her focus from carefully observing others to focusing instead on the natural world around her, a world she knew and understood.
Being, doing and thinking together
As I wrote this, the first page of an article on what are called ‘Adverse Childhood Experiences’ just happened to catch my eye. The article lists all those things that can happen to children and which have detrimental consequences for their mental health. The list of factors makes for pretty depressing reading.
But then it goes on to re-frame these; to put them in a different context and provide another point of view: Understanding these adverse experiences and their impact on young lives, also helps us to think about how some of the damage can be repaired. The research provides, in addition to the depressing list of adverse experiences, also messages of hope. For example, that so much can be repaired by having a trusting relationship with just one empathetic adult who values the child for who she or he is.
It talks of the value of giving the child:
1) attuned emotional responsiveness
2) empathy, and
3) helping the child to talk about their feelings and how they might be able to deal with those.
It just so happens that these three points, emotional attunement (“I am in touch with what you may be feeling right now” – a form of validation if you will), empathy (in the form of communicating my understanding of your experience to you), and enabling someone to find a way to express their own feelings and experiences are key ingredients in therapy, but also keys to effective interpersonal communication.
We know from research on childhood attachment, that anything which allows you to play and be with the child in a setting where you are both enjoying the activity and both can see that the other is enjoying the experience, is vital in building trust and empathy; the ability to relate, self-soothe, and develop resilience along with many life skills. And so talking about things and co-adventuring (through creating and playing together) serve to foster these key ingredients. This brings us back to a question frequently asked by parents: How do I help my child to cope with the lockdown when so many of their anchors have been lifted? No school (unless the parent is a key worker), no play-dates, no activities except staying at home and a little exercise. And one answer lies in re-framing the present experience through:
- being together
- doing things together
- thinking and talking about things together
Stories that promote understanding and coping
I mentioned the words we use a little earlier. In therapy – as in life – we use words to shape the meanings we give to the things that happen to us and, often with even more immediacy, to construct our lived experience day to day. In memory, we combine words and images into the narratives that form the contexts and meanings that give life to our
In therapy – as in life – we use words to shape the meanings we give to the things that happen to us and … construct our lived experience day to day.
respective subjective realities. A key function of therapy is to help contextualise and add meaning to the life traumas I mentioned earlier, and to contain those old anxieties and fears that can get re-triggered in the context of current experiences, even if our circumstances are now different than when those original stories were formed in our minds.
Research has shown that life experiences that promote positive coping and resilience, can help shape one’s sense of coherence, an orientation to life that perceives what happens to us as comprehensible (in some ways understandable), manageable (we have the resources available to cope with them), and meaningful (worthy of engagement). When stressful experiences can be reframed as comprehensible (we understand the necessity for social distancing measures although we find them traumatic), manageable (the current approach enables us to cope to the best extent possible), and meaningful (its worth doing these things as they save lives and help keep us well), the chances that they will become ongoing traumas lessens, and we end up possibly even feeling stronger and more able to cope with future adversity.
In therapy, I routinely use narratives that tap into these ideas: What we tell ourselves about ourselves, our relationships to others, and the way the world is, becomes part of our personal stories, of how we are in the world, of us. We then begin to act, think, and feel in accordance with those stories. And if those stories are stories of distress, senselessness, and powerlessness, then we can be traumatised by them in an ongoing way. And so, to grow and heal, we need to re-write these stories, or aspects of them.
Families create narratives too, we cannot help but create them: There are the narratives we tell children about ourselves and themselves, narratives that children tell themselves, and broader, societal narratives (just look at any news report or the social media trends and you will see the narratives of the day that dominate society, what we think about, worry about, and talk about.)
In our families we have unique opportunities to shape our own and our children’s narratives. Are your lockdown stories filled with fear and hypervigilance, or with compassion, gratitude, hope, and opportunity?
In our families we have unique opportunities to shape our own and our children’s narratives. Are your lockdown stories filled with fear and hypervigilance, or with compassion, gratitude, hope, and opportunity? Do the stories you tell yourself and your children reflect comprehensibility, manageability, and meaningfulness, or fear of the unknown, powerlessness, and hopelessness (which can manifest as despair, or even anger against others, the powers that be, and so on).
The practical application of all of this lies, for example, in the question I frequently get asked by parents of young people I work with: What do I tell my children? They don’t quite understand the information they are being given on the current pandemic. It’s not fully comprehensible. Their narrative may include, “why do I have to keep on doing this?” Or, “adults always tell me it’s important to get out; now they are telling me I can’t”. Or, “It’s OK for mum to go to the shops, but….”
Many children can manage open conversations about the current pandemic. However, some children are not emotionally or cognitively at the stage where they can think about consequences or take in a lot of verbal information.
In these cases, co-creating explanatory, or social stories together with them can help foster their understanding and build their sense of coherence. This article contains a link to a social story by renowned autism expert, Carol Gray that provides an example of just how such materials can be created. If you think your child might benefit from such a story, you can co-create one with him or her.
Facing the pandemic in ways that promote family coping.
In this article, I shared some thoughts based on my clinical experience and what I have gleaned from my work as a psychotherapist in the hope of offering some helpful ideas and tips, especially for families with children. The following 6 ideas summarise my reflections and can form the basis for productive, positive coping family conversations about the coronavirus crisis:
- We have to be mindful that this is a new experience for all of us. There are many aspects of the pandemic we do not understand and our incomprehension may lead to fear.
- Our anxiety about the unknown can show itself in the words we use and the narratives we construct about Covid-19, the lockdown, and social distancing measures.
- Incomprehensible events that we feel powerless to influence can lead to anxiety and being traumatised. Experiences that we are unable to contextualise may be encoded in our memory without their appropriate contexts and potentially therefore can become re-activated and lead to hypervigilance.
- Our narratives may need reframing into coping narratives that reflect our understanding of what is happening, an appreciation and utilization of the resources available to us that may help us get through this, and a clear sense that it is worth our while to engage with this.
- Making sure that our family narratives and the ways in which we interact with our children during this time period foster coping and coherence rather than despair is critical in helping them build their resilience and will most likely strengthen ours too.
- Practical ways we can do this is through developing purposeful explanatory or social stories, playing and co-creating together, and finding ways to be together that communicates attunement, empathy, and sense-making (thinking and talking together about our concerns, opinions and feelings).
If you would like to follow up on any of the ideas mentioned in this article, here are some useful resources:
If you are the parent of a child with autism of a learning disability, you can try and use the following Social Story by Carol Gray, the inventor or Social Stories.
You can find out more about the importance of narrative approaches at the narrative page on : https://positivepsychology.com/narrative-therapy/
The following link is to a document on the power of creative arts to support health and wellbeing: https://www.nhsconfed.org/-/media/Confederation/Files/Wales-Confed/Literature-review-of-arts-and–health-and-wellbeing.pdf
Some ideas on promoting positive mental health among children were drawn from the THRIVE program: http://www.thriveapproach.com
Finally, the following books on how people stay well under adversity may be available from your library:
Antonovsky, A. (1988). Unraveling the mystery of health. How people manage stress and stay well. San Francisco: Jossey Bass.
Levine, P. A., & Frederick, A. (1997). Waking the tiger: Healing trauma: The innate capacity to transform overwhelming experiences. North Atlantic Books.
Wolin, S.,& Wolin, S. (1993). The resilient self how survivors of troubled families rise above adversity. Villard: New York.
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