This feature by Fragiskos Gonidakis is Part 2 of 2 in a series about the experience of a therapist in Greece during the COVID-19 pandemic. In the first part, Fragiskos explored what happened pre-quarantine. Now, in part 2, Fragiskos discusses the quarantine and the initial experience of returning from quarantine.
Before the quarantine (read here for part 1), as reality began to set in, wise mind started to make plans, and trying to find your wise mind was an essential quest on a daily basis. So, what happened when lockdown began?
The Quarantine
When the lockdown was imposed by the Greek government as the positive cases and the deaths caused by COVID-19 infection started to accumulate, the mindful skills of being effective and performing one thing at a time came in handy. If you have to stay inside your house for months what do you do if you are a DBT therapist?
Step 1 – Taking care of ourselves
Each of the four DBT skills groups proved to be extremely helpful.
We needed radical acceptance to help us get into action instead of letting ourselves sink into despair or complain constantly about the unfairness of the pandemic. PLEASE MASTER helped us take care of our bodies, retain a daily routine, and focus on little things that we could do inside our houses in order to build our mastery. We also needed to stay connected with all the people that mattered to us. Calling, texting, posting on social media, video calling, whatever preference we had in order to keep the feeling of connectedness that could help us retain our emotion balance. And, finally, we had to continue our mindfulness practice and remember to stay in the moment even in the long hours of solitude.
Step 2 – Taking care of our team
Being a member of a DBT team meant that we had to take care of our team.
We had to find a way to continue the consultation meetings online. To keep the coherence of the team. To support the members that experienced intense anxiety, despair, or even an exacerbation of their OCD symptomatology related to the possibility of infection. The most important task a team member had, though, was to reinforce the notion that in times of need we have to stand steady and remain loyal to our value of taking care of our community of colleagues and clients.
Step 3 – Taking care of our clients
The most troubling issue with implementing DBT online was how to organise an online DBT skill training group.
When all skills training groups went online, a number of adversities emerged. Some of the members of the group did not have a fast internet connection. A lot were staying with family and there was no private space for them to isolate during the hours of skills training. Checking homework was transformed from a simple task to a complicated procedure. And – most importantly – if a member of a group experienced intense emotions during skills training and disconnected, the second trainer often could not reach her/him to offer support and guidance.
Step 4 – Observing, experimenting, and adjusting
The first month of the lockdown, most of our clients did pretty well. Especially those who were experiencing intense professional stress or suffering from social anxiety were actually relieved, as they were not obliged anymore to go to work or meet friends outside their house. After the first weeks, though, the isolation started to take its toll by causing thoughts of abandonment, financial disaster, and predictions of a gloomy future with multiple losses from the pandemic and no human contact or love whatsoever. So, when we observed that our community started to experience the burden of isolation, we started experimenting with ways to provide extra support and connectedness.
An online group mindfulness hour was introduced on Saturday mornings. The first time only three members appeared. What happened? 9.30 am seemed like a nice time to do mindfulness. Maybe it was too early for people in lockdown? We changed the time to 12.00 and voila! Twenty people showed up. So we practiced and talked and laughed and everyone was thankful for this opportunity to communicate.
The experience from the mindfulness group gave us another idea. What about therapists and clients meeting online to just drink some coffee and chat about what was happening in their lives? The two-hour community meeting was set every Thursday morning. It was an instant success not only for clients, but for therapists as well. We all needed to talk, listen, participate. To join a group of people for a few hours and have some fun. The real revelation was that after a few weekly meetings, the barrier between clients and therapists dissipated. Suddenly we were all human beings coming together to communicate with no other label beyond our names.
Returning from Quarantine
At the end of spring, the lockdown restrictions were gradually lifted. We are still struggling to adjust to the new reality with the everyday announcement of COVID-19 new cases and deaths, wearing masks, continuously disinfecting our hands and struggling to move on with our lives.
When we returned to our day jobs, we dropped the community meeting but kept the Saturday morning mindfulness group. We still do the skills training groups online due to restrictions imposed on group therapy and meeting in medical facilities. Returning to face to face therapy after three months proved to be more difficult than expected but that is probably another story…
As the pandemic continues, we – like the rest of the world – continue to work to find a way to utilize DBT and maintain connectedness.
Want to know more about getting a DBT skills training group online in the time of COVID-19? Read here for the first part of this great three-part piece from Dr. Jim Lyng of British Isles DBT.
Fragiskos Gonidakis is the Associate Professor of Psychiatry at the National and Kapodistrian University of Athens (NKUOA) Medical School. He is currently the Head of the Eating Disorders Unit and Dialectical Behavioral Therapy service of NKUOA’s 1st Psychiatric Department at Eginition Hospital. He has trained in Cognitive Behavioral Therapy, Systemic Family Therapy, and Dialectical Behavioral Therapy. His clinical and research interests are focused on Eating Disorders, Transcultural Psychiatry, and Borderline Personality Disorder. He has worked extensively in training and supervising mental health experts in Greece and Europe in CBT for Eating Disorders and DBT for Borderline Personality Disorders. He has developed two distance learning programs on Eating Disorders and Borderline Personality Disorders that are delivered thought the e-learning platform of NKUOA. He is the co-writer of five books in Greek: “Anorexia Nervosa,” “Talking about Eating Disorders,” “Eating Disorders. Cognitive Behavioral Approach,” “Talking about Borderline Personality Disorder, Dialectical Behavioral Therapy,” and “Ten steps for the treatment of Bulimia Nervosa.” He has published in English and Greek more than 80 papers in psychiatric textbooks and scientific journals. He is currently the President of the “Greek Association for Behavioral Research” and Secretary of the Eating Disorders section of the “Greek Psychiatric Association”.
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