TELE PSYCHOTHERAPY FOR COVID-19 POSITIVE CASES

The Dharwad Institute of Mental Health and Neurosciences (DIMHANS) has come up with tele psychotherapy for COVID-19 patients who are being treated under home isolation. The facility is the first of its kind in the state. There are nearly 1,000 COVID-19 patients in the district of Dharwad, mainly in the twin cities of Hubballi and Dharwad, who are being treated in their homes. As soon as the government gave its nod, many asymptomatic patients in the twin cities here have opted for treatment in their homes.

Those who are undergoing treatment in their homes have been facing social stigma, discrimination by family members and other issues, pushing them into depression. Sitting idle during the treatment period also leads to psychological problems. To help such patients, DIMHANS has come up with a tele psychotherapy facility, wherein Psychiatric Social Worker and Clinical Psychologist and Psychiatric Nursing make phone calls to patients and counsel them.

The district administration has provided eight new landline connections, through which a team of DIMHANS are making phone calls to patients. The district administration is periodically providing a positive case list and it is made available to the staff. I am writing about my experience in working with covid positive cases and their family. The nature of my counseling is through the telephone. The main focus is on the counseling therefore socio demographic details are not collected. However supportive psychotherapy is carried out in more than 600 cases. In clinical observation majority cases were among the adult population with both male and female gender type. Old age people were less in number and the child population was very minimal.

The various types of issues which the COVID-19 patients vent out to the counselors include:

Many people wanted to seek advice/ talk and get support from doctors and professionals. Stress manifests a number of symptoms like restlessness, inability to relax, anxiety, panic, sadness, irritability, anger, boredom, loneliness, poor concentration, forgetfulness, worries, fears, and hopelessness.

During this time due to various issues related to COVID-19 most of them experience stress and anxiety. Clinical observation reveals that anxiety and worries were mild and transient to becoming severe and disruptive. Thoughts related to danger, thinking of adverse/negative consequences like losing family, friends, relatives, transmission to family , job loss , own health, health of loved ones, getting medical help, fear of staying at home, facing stigma, fear of testing positive and anxiety about the possibility of getting cured. Many of them expressed that getting quarantined was in itself a stress.

Counseling process

The counselor starts the conversation by greeting the client and introducing oneself. Thereafter gently asks “how may I help you”. While counseling basic empathy is extended to each client. Their daily routine is assessed in the next step. Next we enquire about their sleep, appetite, feelings of tension/worry/sadness and ask what is most bothering? We try to examine feelings of anxiousness, fear through their voice. We also make attempts to assess feelings of hopelessness, helplessness and worthlessness. Clients are also given sufficient opportunity to express their feelings. Listening to clients empathically makes them feel better. The counseling process is non judgmental and clients are given sufficient time to vent their feelings. Thereafter clients are given realistic evaluation of the situation.

Further clients are taught management of anxiety, provided with positive coping strategies, tips to overcome depressive symptoms, advised on a healthy regular routine, relaxation methods, problem solving, acceptance of the situation, finding alternatives, to adapt to the situation, to not give much importance to thoughts which precipitate anxiety and worries. Most of the clients were taught to schedule the whole day and taught sleep hygiene techniques. Other parameters involved are connecting with family members, friends and discussing happy events, common interests and engaging oneself in activities that give happiness. Also not blame oneself by taking excessive responsibility for what is happening around.