site.btaBulgarian Psychotherapy In a Time of Pandemic

May 7 (Desislava Toncheva, BTA) - The unfolding of the coronavirus pandemic in recent months has completely reshaped public life and affected people in every aspect of their existence, from their physical wellbeing, to their social interactions and economic situation, psychotherapists point out. "It is only natural for existential anxiety to be triggered by current circumstances, and in addition, each person has their own personal traumas and internal psychological struggles, which are now more likely to surface and need attending to," said psychotherapist Lilia Georgieva in a comment related to the psychological side of the current global crisis. She is one of four psychotherapists that BTA's Daily News interviewed concerning the effects of the pandemic on their clients, themselves, their practice and the people around them.

The other three specialists who shared their observations here are psychotherapists Elena Ilieva, Mariya Atanasova and Stoyan Kuzmanov.

Private Practice in a Time of Pandemic

Like many other areas of public life, following the announcement of the pandemic and the imposition of social distancing measures, many private practice psychotherapists in Bulgaria also moved their "office" to various online platforms, usually Skype or Zoom. This type of therapy existed before the state of emergency, but is generally less commonly preferred to standard live weekly therapeutic appointments.

The therapists explained that changing the modality definitely affects the process, but in a different way for everyone. Some of them prefer to work with clients live and are already considering options to open their office for specific clients, with increased safety measures. Others have adapted quite well to this way of working, even holding group meetings online. Among them is the Director of the Bulgarian Institute for Gestalt Therapy, Elena Ilieva, who even managed to organize online modules for therapists-in-training, and also offered a number of one-off free counseling sessions for people seeking support in adjusting to the crisis.

Psychotherapy Clients in a Time of Pandemic

According to the therapists, clients respond differently to the new conditions: some postpone therapy for a future date because of lack of personal contact in online sessions or because of insufficient personal space at home, while others manage to find safety and comfort in this new type of communication. The specialists interviewed do say the number of their clients has declined during the state of emergency, mainly due to financial reasons, but also that the crisis has led some people to begin the therapy they have long-postponed.

The nature of the topics the therapists work with and the clients they attract however have not changed much. Most clients continue to work on their major topics related to anxiety, traumas, depression, existential issues, as well as a desire for change, self-awareness and development, and an overall increase in the quality of communication and life satisfaction.

The financial instability that the crisis has brought is an important thing to note, as it certainly brings a lot of tension. "A lot of my clients are experiencing fears about the economic consequences that are already happening and will develop in the future," says Stoyan Kuzmanov.

"At first, my clients seemed to forget about their problems, the crisis shifted the focus from their usual suffering and their accompanying symptoms disappeared during the first one or two weeks. After that, anxiety and panic set in, in some cases even psychotic experiences, and their symptoms come back, sometimes accompanied by a tendency for depression,'' summarizes Mariya Atanasova.

An interesting fact shared by two of the psychotherapists is that some clients, usually ones suffering from depression, anxiety or obsessive-compulsive disorder, are paradoxically feeling better than before. "In the current situation, they are not the exception, but have similar experiences to others, and actually manage to support others because they know this state well," says Elena Ilieva. Mariya Atanasova adds that these people are now in their element and feel useful to others with their knowledge. This observation is also shared by some foreign therapists.

Lilia Georgieva believes that the conditions of the current situation contribute to much deeper therapeutic work in many cases. "Clients are fully present, the sessions develop spontaneously, and are devoted to their most cherished and intimate topics, topics related to shame, rejection and self-hatred, negative feelings for loved ones, violence, etc. Clients are more inclined to dive into what is unpleasant and painful, in order to update, illuminate, redefine and accept it and to get rid of the old refrain of their story, " she said. Lilia is not sure to what extent this is affected by the crisis and to what extent it is facilitated by working online, which does bring a certain amount of support through the boundary of the screen and the security of one's home.

Bulgarians in a Time of Pandemic

The therapists describe the impact of the crisis on Bulgarians in both a positive and negative light. "Since the very first days of 'social distancing', which is more properly called 'physical distancing', I noticed a lot more manifestations of empathy, willingness to help and tolerance. Social engagement has definitely increased," notes Elena Ilieva.

"It is different for everyone of course, but I noticed that many people say that (this situation) comes to them at the right time, and many people have began engaging with their own fears and problems, which they have long put aside. On the other hand, there is a widespread worry about the financial side of things, that it may make it make it impossible for people to meet their basic needs,'' says Mariya Atanasova, adding that, as a whole, people are managing to adapt to the new reality.

Stoyan Kuzmanov also shares this opinion. "At the moment, many of the people around me are doing well and adjusting to the different rhythm of life. Parents of young children (up to 7-8 years old) face more challenges in the 24-hour communication with their kids at home and have more moments of "freaking out". In recent days, I've also had the observation that, as if there is a clearer division of two groups of people: some who continue to abide by the isolation, have a fear of the virus and care for their health, and others who have exhausted their patience and approach the situation with anger, distrust and anxiety about what is ahead, they just want to come back to their familiar rhythm of life," Stoyan points out.

Lilia Georgieva also highlights these two types of people in her observations. However, she notes that those who think they are "above it all" and ridicule and deny the situation sometimes are not aware of their own anxiety and do not relate to it in a healthy way. This existential anxiety often manifests itself in psychotherapy in the form of constantly emerging new problems, such as fear of loneliness, aging and death, which can lead to severe hypochondriac conditions and panic attacks. The therapists are adamant that healthy association with and acceptance of the existence of an existential anxiety is not only natural, but also necessary.

Lilia believes that people could take advantage of their УpauseФ and devote some time and attention to themselves, give space to their internal processes which need to unfold and be tended to, and fully feel and experience them in order to reach a moment of closure. DT//
/МТ/