Audio Update Archives

Karen Cohen pro-bono initiative

A child and youth psychologist wants to help out – what can they do?

Because the scope of the service is to provide help to adult health care workers, it’s important that whoever signs on has that competency. Obviously psychologists who work with families and kids have important contributions to make. But given the initiative is aimed at adults, it will be important that anyone who signs on has the competency to work with that age group.

We’re also getting some questions from Quebec – a lot of psychologists there want to sign on. Is there a different process for them?

Everything’s been translated – the materials, the lists, you’ll notice that on the listings [of psychologists who have signed on to do pro-bono work with front line health care providers] some key things. The psychologist’s name, their coordinates, where they’re licensed, and what languages they speak. So absolutely! Un grand bienvenue à nos collègues à Québec – we welcome your participation, and that would be a huge contribution!

Christine Korol quick chat coping if you are already dealing with anxiety, OCD, etc.

Let’s talk about coping with this current situation if you are already dealing with something like anxiety, OCD, or another issue of that nature.

It’s hard, and you’ll have to do this on an individual basis with your clients. I have a lot of people who are making terrific progress, whether they have social anxiety or a bit of agoraphobia, and they’re getting out of the house more. They’re back in the house now and a lot of them are telling me “you know, I actually know how to be okay in here”. So they’re okay but they’re worried about how to manage when this is all over. I remind them the learning curve will be shorter, they know what to do, that they can continue to develop connections and find meaningful things to do while they’re in isolation. That’s been tough.

For OCD cases, the patients that I’m working with that are afraid of germs or that wash their hands too much, we’ve been working a lot on sticking to guidelines. I’ve been emphasizing too that this is not like regular germs or viruses, this is not something we have an immunity to, and we have a very high risk of complications for other people. So we have to flatten the curve right now to help health care workers manage with the influx and protect the people that we care about.

So this is a very unusual situation and hopefully in a year, or however long it takes, we get through this dark tunnel and come out the other side. Another issue is that uncertainty, with anxious people, that’s something we’re working on too. Once we get through that tunnel public health will direct us to what is safe again. Many of my patients are hand washers, and we talk about how they’re washing their hands much more than surgeons are. So we try to keep it within those bounds recommended by public health.

For some of them, they’re still worried about contamination from things that aren’t high-risk for spreading COVID-19, which might be things in their house or they’re afraid of touching the bottle of bleach or other things. So we can still work on that. There are some interesting things you can do with tele-therapy. I’ve actually been using tele-therapy to kind of do home visits with OCD patients for some time now. That hasn’t changed, so I can still do things like exposure therapy. They can show me if they’re afraid of their laundry room, or afraid of cleaning their toilet, we can still work on that kind of stuff remotely.

Christine Korol quick chat the fear of losing someone

I know a lot of us are feeling this right now, the fear of losing someone close to us. Yesterday my neighbour stopped by, and we stayed far apart in the driveway and had glasses of wine (each from our own house) while she told us her grandmother had just died in Germany. And we couldn’t hug her, and we couldn’t comfort her the way we normally would. It all had to be done from a distance.

It’s just so brutal, what’s going to happen. I’ve heard some predictions that everyone’s going to know at least one person who died from COVID-19. And that’s if it goes well – we’re all going to know at least one person, if each person knows about 300 people. And it’s not that big a stretch to imagine that.

So it’s no funerals, no touching, no comforting, no hugging. It’s going to be very hard to help people process all of this. Therapists need to make sure that they take care of themselves, and that they have people to talk to and process this information. It’s a good time for therapists to brush up on grief therapy, and to be comfortable having those conversations with people about the loss of their loved one. There’s a lot of education about the ‘trajectory of loss’, about how long the raw pain lasts, what causes a complicated grief, and how to help people if there is a complicated grief.

There is going to be a lot of loss and trauma coming up. How we can help people with that is really knowing how to talk about loss and grief. And then for some people if they’re at higher risk, and they think they might lose that person, if they’re worried about an elderly relative for example, encouraging them to talk to that relative now. To make the most of the time we have here.

What can help reduce anxiety around death and loss is to actually talk about a death plan. Find out what your family members want – and we should actually be doing this anyway – but it does reduce anxiety if we can be open with them and talk to people about death. For the people who have been coming to me worried about grandparents or people with immune disorders or pre-existing conditions, I’ve been encouraging them to openly talk about death with their parents or grandparents and say “are you worried about this, is there anything I can do?”

It’s often a relief for people when you can talk about death. I think that would be an important part of public education as well, that we really don’t talk about death. You know, 100 years ago people used to wear black for a year to signify they were in mourning, and the community would rally around them. People had wakes in their homes, and would die at home, and so there was a greater comfort with death. There was still the pain of death, and people understood that people in mourning needed support, but we really need to understand that death can happen at any time and so we need to have those conversations with people.

It’s not morbid, it’s the reality of our situation. Maybe we can have those conversations and not leave our at-risk family members worrying and pretending that everything is okay. They can have these conversations and that will reduce their anxiety.

Christine Korol quick chat anger toward people who are not taking COVID seriously

You’ve spoken about people who get angry when they see others not taking COVID seriously. Some of those angry people have been health care workers, but what are you seeing from the general public?

What I’ve been telling people is that everybody copes with stress differently. And I think there haven’t been a lot of clear messages up to this point. Things are getting clearer now, but you see different restrictions in different communities, and in different provinces and different countries.

There’s a lot of information coming at us, and the communication on an individual level of what you should be doing in your community is actually kind of hard to find. I try to keep up to date with it myself and I find it rather difficult at times so hopefully that becomes clearer.

Public health has to be the one to police people. You can’t be the COVID police. You also don’t know how people are coping with this, and some people cope by not turning on the news. And that’s something that we tell people to do all the time. If you’re feeling anxious stop watching the news 24/7. But in this case you do have to watch some news because it is changing so quickly every day, so you know what you’re allowed to do and not do.

So when you get angry with friends or family members or you see someone you don’t know on the street or gathering in groups, it’s important to know we’re autonomous people. We have to make our own decisions. We’re all processing this difficult decision differently. And some people are dealing with their anxiety by going outside and not reading the news. So you have to be patient with people, and understand that this is a difficult situation, it’s unprecedented, but it really takes a larger voice than your own to change somebody’s mind about what’s safe and what’s not safe.

Plus you know I run an anxiety centre so a lot of my patients tend to be kind of nervous, and their families kind of tune them out. So I bring that up with my anxious patients, that it’s almost like people look at us like we’re Chicken Little when we’re anxious. That we say “don’t do this” and “don’t do that” and now it’s “here we go again with COVID-19” and they’re not taking it seriously. And you might not be the person to change their minds.

So anger with these people is unproductive. But I’m wondering how I can convince my 70-year-old mom, who lives in Winnipeg, that she’s not going to be able to keep her church basement bookstore open.

Yeah, you won’t be able to do it, probably. I’ve never been able to change any of my relatives’ minds. About anything.

Okay, then I will accept that she will keep it open, and hope no one goes to visit while she does (since the time of this interview, the bookstore has indeed closed).

Yep, you kind of have to rely on the city or the province to enact those guidelines. Each day here in Vancouver it seems like another category of businesses is being closed down. Psychologists were Monday. I closed my practice down last week so I’m in tele-health now in my second week. But it was just a few days ago that we got our directive to move to tele-health, from the public health officer who relayed the message through the colleges here in BC.

So it’s going to have to be legislated. Even if it’s a smart thing to do to shut it down, you can’t force anybody to shut it down including family members. Patience is the antidote to anger! You can maybe ask them why they don’t want to close down. Why it’s important to them. Be curious! What are they afraid will happen if they do close down? Maybe you can find out a little more about why they’re doing this instead of just assuming they’re being stupid and ridiculous and being a danger to everybody else.

Be a little curious about what they’re doing because at this point you do want to keep your relationship strong through this. Be supportive and be someone that they can come and talk to when they eventually do have to make that decision. So when they say “I had to close the bookstore” you’re not going to say “see I told you so”.

Christine Korol quick talk front line health care professionals

You have already been working with front line health care providers – doctors, nurses – how are things different for them now?

Everybody’s gearing up while they can, knowing it’s the calm before the storm. It’s hard working around colleagues as they get more anxious. There’s a lot of talk of death, and getting wills in order, fear that they’re not going to have enough protective equipment. Worrying about having to make difficult choices. Worrying about having to care for colleagues who get sick.

I’m hearing all kinds of things right now that health care workers are afraid of. Both from colleagues and patients who might be health care workers that I’m seeing. I work in a lot of hospitals too, myself, so I have a lot of friends there.

As we’re moving toward providing pro-bono psychological services to front line health care workers, what advice would you give psychologists who take this on as they’re making that first contact?

Listening, and asking what exactly people are worrying about. Typically what I’ve been saying at the start of sessions is “there are so many things to be worried about with COVID-19, what are the particular worries that you have? What’s been hard? What’s been stressful? Because it’s not the same for everyone.

I don’t go in assuming that they’re worried about moral distress about making decisions for patients, when they might be worrying about their own safety. You might be surprised at what they’re worried about. This is going to be rapidly evolving, and typically what’s traumatic for people are not the things you would expect. Doing a lot of trauma work myself, I’m always surprised at what causes people to feel bad or guilty.

So asking them to give a good detailed description of what it is that’s stressful for them now. I’m a cognitive therapist so I go looking for ‘hot thoughts’ – what they’re thinking, and then pause and maybe say “I want to stop you – so you think it’s your fault that this went wrong with this particular patient?” So I’ll go looking for places of guilt.

I’m doing a lot of listening now and there are not a lot of people who hear what health care workers are dealing with. They’re going to be grieving, they’re going to be traumatized, and it’s not something they can talk about with friends and family. It’s even going to be hard to talk to colleagues about it because they won’t want to upset anybody else. So therapy can be the one place where they can really have those open and detailed conversations about the things that are causing them distress.

As you said, it’s rapidly evolving. Presumably what’s worrying people today is not what’s going to be worrying them a week from now, or two weeks from now.

Yes, everybody’s kind of mobilizing and getting ready at the time we’re doing this interview. In some areas of the hospital I’m hearing that, for example the ER is very quiet, and the regular public is basically staying away. So it’s eerie and strange, and then it’s going to get busy really fast. Then we’re seeing photos from New York. I saw a photo of a group of nurses in New York wearing garbage bags for protective gear. We’re going to see more images like that and health care workers being really upset.

I’m also right now seeing health care workers being really upset with people walking around and not caring – not listening to physical distancing recommendations. That’s been the theme of the week, actually. Not just with health care workers but I certainly hear that a lot, you know, “don’t people care?” So it’s very hard for them to see that.

Quick talk with Dr. Christine Korol about tele-health and online therapy

Can you give me a nutshell overview of taking your practice online? How does it differ from an in-person therapy session?

There are a few things to learn when you’re moving to an online practice. Typically it’s understanding a lot of what tech to use safely and to get comfortable using tech. A lot of therapists are intimidated so a big chunk of what I teach is how to evaluate the safety of a tech, not to be intimidated by a lot of the technical language, and how to do a privacy impact assessment.

After that it’s how to get your patients comfortable doing online therapy, teaching them about keeping their conversations with you private and safe, finding a good location, having secure internet, not using public wi-fi or wi-fi at a coffee shop. And having backup, especially if the person’s not in your community how to reach emergency contacts they might have if you’re concerned about their safety. Knowing where their family doctor is in their community can be a good option.

There are many technical things to think of and then after that the practice of online therapy usually involves a little bit of tweaking – understanding that clients often feel more comfortable in their own homes, so they over-disclose a little bit. So how to contain that, how to keep people engaged. I think most therapists have the experience of doing a crisis call with a client over the phone, so it’s not as hard a transition as they think. It’s a lot of practical training for us just to keep it safe and pick the right tact.

What does it mean that someone might “over-disclose”?

That means that they’re a bit more comfortable so maybe they talk a bit too fast or go too deep a little too soon, whereas they might pace themselves with what they talk about in a face-to-face session. We find that for example in email therapy, people write down more than they would be willing to share otherwise, and then they’ll maybe have some regrets about that or feel uncomfortable about it. Especially with trauma, we want to pace it out with people and slow them down a little bit so some of it is knowing when to pause and say “I want to ask about something else first before we go deeper into that”. Also knowing how to structure the session a bit so people don’t go too fast in therapy.

When you do tele-therapy yourself, what is your tech setup?

I have very high-speed internet so that from my end the connection will be smooth. I make sure my router’s encrypted and that I have an up-to-date router. Routers are actually very important in terms of security. If you have a fairly up to date router and keep it well maintained you should be fine. I have a device that I know is secure and I store no data on my device – I use electronic health records, those are in the cloud, and I make sure I use a video platform that meets privacy standards.

Even little things that people don’t realize, like you have to keep your device safe too – make sure it’s password protected and when you’re not using it treat it like a file. If there’s any data on it lock it in a filing cabinet. It’s practical things – security of the device, security of the platform, knowing where all your data is stored in different locations. And making sure at a simple level people can’t hear you doing your therapy sessions while you’re in the other room.

I presume keeping other people out of your space is paramount while you’re doing online therapy.

Absolutely. I’ve been doing tele-health for many, many years so this was a pretty easy transition for me. Although moving into ALL tele-therapy has been still a bit of a learning curve for me so I’m settling into that this week. This is my second week of all tele-health. At first I was going into my office and doing it from my office at work, even for remote patients, because it was completely secure there. Now that I’m working from home I have a white noise machine that I put out into the living room just outside the door where I’m working so none of my family can hear what I’m doing and I keep the door closed, so it’s very private.

Sort of like one of those red lights outside a studio so you don’t walk in while someone’s recording.

Exactly! Except for therapists it’s a white noise machine.