Q&A with Psychotherapist Nicky Perl on confinement during COVID-19

Psychotherapist and counsellor Nicky Perl is among 1000 therapists to support Duty to Care’s work in providing NHS staff with mental health and wellbeing support. With a particular interest in working with anxiety and trauma, Nicky is currently working with her clients to cope with confinement and illness during COVID-19.

How have you been coping during lockdown?

N: Initially, like many other people, I struggled with lockdown and the sudden loss of contact, freedom and being able to make plans. I had to think very carefully about how best to support my clients – especially as so many of their anxieties were merging with my own. I found that I turned into a prolific baker and whilst I found it relaxing to kneed or fold in the time between clients,  I began to feel overweight and sluggish and realised that I needed to find healthier ways of supporting myself. I increased my own clinical supervision, hired a spin bike and tried to curb my new baking habit! As a result, I began to feel much more able to support myself and my clients.

Has it had a big impact on your lifestyle and the therapy you offer?

N: Obviously the biggest impact on my work was being unable to see clients face to face at Aashna, the therapy practise where I work and having to move to Zoom sessions. Initially, I was somewhat apprehensive about how this would work but was pleasantly surprised. The benefits of Zoom very much outweigh the negatives. I am able to be incredibly flexible when booking in clients (and this was particularly useful for my DTC clients and their ever changing schedules). The main negative of working on Zoom was that it was tiring – it’s more intense and seems to require a different type of concentration to ensure that nothing is missed.

Can you explain the psychotherapy and counselling you offer?

N: There is a confusing array of different trainings, modalities and approaches when it comes to therapy. I know that it can be a real minefield for clients trying to work out which approach best suits their needs. My training is integrative which means that I understand different schools of psychotherapy (for example, psychodynamic, person centred, Gestalt, trauma and the body) and, as such, I can really look at the individual client and their needs, drawing from a wide range of ‘tools’ and approaches.

I have a post graduate diploma in counselling adults and undertook a further four year training to obtain a second diploma in working with children and adolescents. I am currently at the final stages of a Masters in child and adolescent psychotherapy. Whilst I now work exclusively in private practise, I’ve had some fascinating placements along the way – working as a bereavement counsellor for Marie Curie, as a counsellor in school and setting up a counselling service at a GP’s surgery.  

Interestingly research shows that the main determinant when it comes to success or failure of the therapy is the therapeutic relationship itself and this is what I base my practise on; I work very relationally and am not a ‘blank ‘screen of a therapist but offer a warm and containing presence. 

Who would your therapy benefit – is it particularly good for those suffering anxiety or depression?

N: Whilst I think that therapy has the potential to benefit anyone who wants to understand themselves and to challenge old ways of relating and thinking, I’ve found that most of my client base comprises those suffering with anxiety and depression. I’m not sure whether this is a general trend or whether it is because I have a particular interest in these issues and these clients seem to find their way to me! 

I’ve done additional trainings in CBT, ACT and have supported my interest by reading extensively in this area too. Other aspects of the work have included normalising client’s emotions, being a containing, safe presence and sounding board for difficult thoughts and feelings and offering some psycho - education around trauma and the body too. I have often quoted Winnicott’s concept of a ‘good enough’ mother – that the work they are doing is certainly ‘good enough’.

How could it help support NHS staff during/after Coronavirus?

N: COVID-19 is a great leveller and seemingly does not care much for training, status or job description. Each and every one of my clients have talked about ‘imposter syndrome’, the uncomfortable feeling that they are out of their depth and will be found out at any time. Whilst this is something that I’ve often seen clinically (and is frequently linked to past feelings of not being good enough and a critical internal voice), I have been very struck at how prevalent it is amongst my Duty to Care clients and soon realised why. 

The healthcare crisis has displaced people – for example, people suddenly thrust from the relative security of an office-based job, to working in the ICU department or being taken from one department to another. I have come to realise that the NHS is hierarchical and structured. However, it appears that there has been movement in the ranks; often a rapid escalation from the lower levels to the sharper point of expert, critical, often end of life care.  Unsurprisingly my clients have felt out of their depth. Therapy has proved to be invaluable with these clients, working on self esteem and helping to support anxious thoughts and feelings.

What could clients expect from a first session with you?

N: I don’t offer a formal assessment, asking potential clients to fill in forms and answer lots of questions about background and history. That’s not to say that I am not interested in these things but my approach is to listen and to focus on salient background issues as they arise. To my mind, the two most relevant questions are simply ‘why therapy?’ and ‘why now?’ I also understand that the first session with a therapist can be incredibly daunting and many clients can feel quite overwhelmed or dissociated. It’s important therefore to put people at ease.

Are there any symptoms NHS staff should watch out for as a sign they may need extra support?

N: Insomnia / changes in sleep patterns, lack of appetite, feeling overwhelmed, failing to enjoy family, friends and leisure pursuits are all signs that someone may need extra support. I’m curious that my Duty to Care clients have often needed the encouragement of colleagues to access support and wonder if this reflects something of the ethos of the NHS – to just carry on. However, when a person is hyper or hypo aroused, they are unable to self regulate and typically this means that work life starts to impact non work life in a negative way. Interestingly many report that they are so busy looking after those around them, that they fail to look after themselves and can lapse into poor patterns such as not exercising, eating badly etc. 

Can you offer any advice for anyone struggling during lockdown?

N: Please don’t! As a therapist I am not usually this directive but there is just no need to suffer when there is excellent support on offer via the DTC website. Take the time to pause and reflect on what you are feeling and thinking and how you could achieve better mental health. Ask those around you how they feel you are coping and listen carefully to their response. The psychiatrist and Holocaust survivor Viktor Frankl writes movingly about how we do have choices, even in the most dire situations - one positive choice could be to access support via DTC however daunting this may initially seem.

You can find out more about Nicky via her website: WWW.PERLTHERAPY.COM

Or email NICKY@PERLTHERAPY.COM to book a session.