Abstract:

Integrated  imagery rescripting based clinical approach to patients who are suffering due to the pandemia

Patricia Rotman

This short presentation will describe how we can help existing and new patients to better cope with these unprecedented times.  It will include some helpful information about different diagnosis, screening tools , a quick literature review of research about early  interventions with recently traumatized patients (who are having ongoing  stressors)  and some practical clinical strategies including recommendations of “ what to do” and  “what not do do” (e.g, with patients who are emotionally dysregulated).

It will include some examples of working with health care professionals who are “in the trenches”  as well as working with patients who are living in New York City,  the epicenter of the pandemic  in the USA.

COVID-19, Dissociation, Trauma and Schema Therapy

Astrid Ingham Brooke

On New Year’s Eve at the beginning of 2020, would you have predicted that in a few months’ time you would be socially isolated, working from home and not seeing friends and family?   And that even getting a mild common cold might be a cause for concern?   What happens when the “unthinkable” happens?   When there is a global pandemic and country after country goes into Lockdown, the virulence of Covid-19 shatters all our assumptions about our vulnerability, control, predictability and the “Meaning of Life”.   In a matter of weeks our whole world has changed.

As schema therapists we are used to treating patients with a history of complex trauma.   The threat of Covid-19 is triggering people.  Patients who had previously been “doing well” report having panic attacks, overwhelming anxiety, some may be dissociating.   Their OCD flares up, they may feel spiritually defeated, depressed and suicidal.   Some experience interpersonal tensions in crowded homes, with anger and frustration spilling out into family splits and domestic abuse.  Others may feel lonely, abandoned and hopeless.   All of us are vulnerable to some level of grief, loss and pain.   We may be unable to grieve or allowed to give due honour to our dead.     Jobs and livelihoods disappear, businesses fold, some people face financial ruin.   What does the future hold?  How do we live with so much uncertainty?

The threat of Covid-19 affects therapists as well as patients.    We may be stressed or even traumatised depending on our situation.    We too find that our world is not as reassuringly safe or predictable.   We may react with initial shock, denial, or with panicky overcompensating activity until we recognise this is happening to us too.    Disease control measures such as Lockdown or Social Distancing challenge us all while we try to adjust to different ways of living and working from home (WFH).    Online therapy saves our clinical practice but is another adjustment to how we work.  We too are socially isolated, distanced from colleagues, family and friends.  Social isolation may affect our ability to be a “safe container” for patients’ distress.  We may need to “ground” ourselves as well as being a Healthy Adult for our patients.

This webinar looks at common reactions to psychological trauma and stress and considers how similar processes may be relevant in the current crisis.   The early evidence from Wuhan suggests there may be serious psychological challenges for health professionals and the general population during the pandemic and afterwards.   Like a virus, trauma or stress can happen to anyone and no one can accurately anticipate how they will react in a crisis.   Therapists are not immune, either from Covid-19 or psychological stress.    We are all in this together.    Our patients may be openly distressed or depressed and withdrawn.  They may be puzzled and demoralised by their own reactions.    Some may be highly dissociated and emotionally “unreachable” which is challenging for therapists working remotely through media screens.   If therapists are stressed, their own responses or activated schemas may also affect interactions with patients and the therapeutic bond.   This webinar begins to identify and address some challenges and risks for online working with complex trauma, including working with severely dissociated patients.  Therapist variables are also considered, including therapist self-care and the potential for vicarious traumatization and burn-out.

About the Presenters:                   

Patricia Rotman:

Dr. Patricia Escudero Rotman has been in practice for more than 25 years, both in the United States (mostly New York City) and Argentina. She is a Clinical Psychologist licensed in Argentina , holds an American Ph.D. in Health and Human Services (with a Specialization in Psychology)and a New York License in Social Work. She has trained in many schools of thought but has specialized in Cognitive-Behavioral Psychology and Schema Therapy. Dr. Rotman is an Assistant Clinical Professor in the Department of Psychiatry at Mount Sinai School of Medicine inNew York. As a member of the faculty,she created the Schema Therapy class for third and fourth year residents. After living in the US for 23 years, Dr. Escudero Rotman moved back to Argentina where she founded and directed an official Schema Therapy training in Buenos Aires. Since her arrival, she has given many ST presentations to professional associations in Latin America (e.g., Association of ArgentineanPsychiatry, ArgentineanMedical Association). She co-founded the ISST Trauma SIG and has been coordinating this group since 2016. Her areas of expertise include trauma work,multi-cultural issues, and the integration of both CBT and Schema Therapy. She does online and in person therapy, clinical supervision, and training.

Astrid Ingham Brooke:

Astrid Is a Clinical Psychologist currently practising in Windsor, England, United Kingdom. She is also an Advanced Level Schema Therapist, Supervisor and Trainer in Schema Therapy for Individuals, providing ISST-accredited training and supervision to NHS psychologists, forensic psychologists and other mental health professionals working in both the public sector and private practice.

Astrid grew up in England but lived for many years in Australia.   She studied at the University of Sydney and worked in in both public and private sectors in New South Wales, working in hospitals, university departments and primary care.   Her main clinical areas of interest were affective disorders, psychological management of chronic pain, and psychological trauma.    Astrid worked as a psychologist in university departments of psychological medicine on diverse projects such as anxiety disorders and menopause.   She set up three chronic pain management programmes in different organisations (public and private), providing both direct services to patients but also training staff to support patients coping with chronic pain conditions.    

Astrid worked for Davison Trahaire, a firm of private sector psychologists providing a range of psychological services to staff and emergency services first responders.   This included attending critical incidents such as armed holdups, fatalities at work, providing psychological first aid, supporting staff returning to work, and providing longer term assistance to employees in their workplace.    Astrid has worked in the field of psychological trauma for 29 years.

Astrid returned to England in 1991.   She studied at the University of Birmingham for her clinical doctorate, and at Aston University to obtain her Work Psychology and Business degree.    Astrid then worked in NHS in the West Midlands, providing psychological services for adults with a range of complex issues including BPD.

Astrid was a Consultant Clinical Psychologist for 13 years in Berkshire.  She worked in a service where there were patients with psychologically complex and long-term conditions, including BPD.   The pioneering work of successfully treating BPD using Schema Therapy in Holland and America inspired her to seek ST training in 2008 and later to become an ST trainer herself.