A letter to Psychology: Grieving the old, accepting the new

Elizabeth Haines, Lauren Taylor, Rachel Ison, Sarah Dunstan, Sarah Hollingsworth, Jessica Blumsom, Holly Ellerton and Danielle Hills.

Dear Psychology,

You were referred following the loss of normality due to the Covid-19 pandemic. Together, we thought about how this has impacted your life. When we first met, you were in a state of shock, and throughout our sessions we explored how you were experiencing a period of grief after this traumatic event. As a way to make sense of your different emotional states we used the Kübler-Ross model, also known as the five stages of grief (Denial, Anger, Bargaining, Depression and Acceptance). We spent some time thinking about how the grief process is not linear and acknowledged there may be bumps along the way. Accepting the fact that your journey will be ongoing was a crucial theme throughout our work together.

You were initially in denial about losing your ‘old normal’. You shared that you would continue seeing service users face-to-face, ensure that you attended all training opportunities and spend time socialising after work. As we examined the stages of grief we noted how your denial may have been a coping mechanism, to manage your uncertainty at this time and to shield you from your immediate shock, allowing you to detach from your emotions.

As it became clear there was no short-term solution and crisis plans were implemented, you expressed a great deal of anger. This anger was directed towards 'higher powers' who you perceived as responsible for the loss of your ‘old normal’. You were infuriated that you could not deliver the service you wanted due to staff redeployment, illness and government restrictions. You worried this would result in ruptures in therapeutic relationships you had worked hard to build. You were further frustrated by the loss of professional and development opportunities and mentioned how 'unfair' it felt that this had happened to you. 

At times you expressed desperation for life to be as it was before Covid-19, particularly given your concern that there would be a further mental health crisis following the pandemic. We recognised how your thoughts were centred on ‘if only’ statements and ones such as “I will do whatever it takes to prevent mental health services struggling even more”. Whilst your level of commitment was commendable, we acknowledged the drawbacks of bargaining and upon later reflection you identified feeling “false hope”. By processing these difficult emotions, we were able to start negotiating a way forward towards your ‘new normal’. 

Along the road to your ‘new normal’ you described feeling overwhelmed and hopeless as you were working really hard to support all your friends (other NHS organisations, teams and staff). You explained that you felt burnt-out trying to meet the unrealistic expectations you had set for yourself, and disempowered by your lack of control over the situation. We used Seligman’s theory of learned helplessness to understand your low mood during COVID-19, and identified how you were experiencing universal helplessness as you felt “nothing could be done”. We wondered if this helplessness was preventing you from meaningfully responding to COVID-19 in a way that aligned with your values. We used cognitive defusion strategies and mindfulness (e.g. leaves on a stream), to make sense of how you react to your thoughts and feelings.

You began to accept and adapt to your ‘new normal’ in the following ways:

  • Increasing support for the wellbeing of NHS staff – you achieved this by providing helplines, wellbeing rooms, reflective spaces, supervision and consultation. 
  • Enhancing the flexibility of service delivery – you published guidelines on how to adapt psychological therapy using digital technology, with consideration of factors such as consent and confidentiality. You have also adapted service provisions to support accessibility such as flexible working hours and days.
  • Supporting local and national initiatives – you provided psychological education for the public about coping with COVID-19. You hoped that this would inform the government’s response by helping to implement policies that ensure the collective trauma is responded to in an appropriate and evidence-based manner. 
  • Contributing to societal behaviour change – you have shared your knowledge of psychological theory to aid understanding and normalise responses to the pandemic. You thought about the factors necessary for behaviour change, such as motivation, perceived behavioural control, subjective norms and self-efficacy.
  • Undertaking, disseminating and monitoring research – you utilised critical thinking and analytical skills to inform service developments during COVID-19 and beyond, ensuring that decision making is based on credible data, as well as gathering data for future research.
  • Advocating for social justice – you have taken a leading role in liaising with third sector agencies to think about how to manage the rise of social issues such as domestic violence, unemployment, school closures and increased pressures on carers.

During our sessions we also thought about the positive outcomes from the COVID-19 pandemic. For example, you hoped that services would become more inclusive and diverse due to the increased use of technology, ensuring cheaper and flexible access to care. You were curious about how services may become more systemic in their work, given the potential to connect more easily with a service user’s wider network. Furthermore you expressed relief at the additional funding that had been received to support services. However, you feared that these positive changes might not be sustained long term.

Over the last year we have acknowledged that your progress is ongoing, and your grief may be too, but in the face of this pandemic you have shown resilience and post-traumatic growth. Accepting your ‘new normal’ has allowed you to see yourself from a strengths-based perspective, and you even described a realisation that there are some parts of your ‘old normal’ that you feel should be left behind, for example the limited methods of service delivery. I know that you will continue to show determination to move towards your ‘new normal’ and you should be proud of what you have achieved so far. Remember you are reflective, hard-working and compassionate. 

I wish you the very best for the future.

Yours sincerely,

The New You

- Elizabeth Haines, Lauren Taylor, Rachel Ison, Sarah Dunstan, Sarah Hollingsworth, Jessica Blumsom, Holly Ellerton and Danielle Hills are CAMHS Assistant Psychologists

The order of authors was chosen using a random list generator. Each author had an equal contribution to the writing of this article. 

We would like to acknowledge the special contribution of Dr Heidi Trivasse (Clinical Psychologist, CAMHS Targeted Team) for her advice, support and time throughout this process.

References

Ackerman, C. E. (2019, July 12). Learned helplessness: Seligman’s theory of depression (+ cure). Retrieved from https://positivepsychology.com/learned-helplessness-seligman-theory-depression-cure/

Harris, R. (2019). ACT made simple: An easy-to-read primer on acceptance and commitment therapy. Retrieved from: https://www.charlestoncounselingportal.com/uploads/1/2/1/6/121600458/act_made_simple_manual-russ_harris.pdf

Kübler-Ross, E. (1969). On Death and Dying. New York, NY: Scribner.

Seligman, M. E. (1972). Learned helplessness. Annual Review of Medicine23(1), 407-412.

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