A Day in the Life of Sean McGoldrick, PBNI Psychologist.
The COVID-19 lockdown has brought mental health and addictions into sharp focus. The pandemic has increased stress, fear and anxiety and those who have poor mental health and who struggle with substance misuse can be particularly vulnerable. That is why the PBNI Psychology team has developed new ways of providing psychological support to those most in need.
As part of the Psychology team I deliver Cognitive Behaviour Therapy (CBT) to people who are subject to court orders and provide assessment for those on the substance misuse court.
Before the lock down, my day was structured and it followed a similar pattern. I travelled between probation offices in County Down and County Armagh, as well as Laganside Court in Belfast. Relationships and communication are of vital importance and the weekly visits to each office, allowed us to catch up with each other, and build a good rapport. I always found that the journey home provided time to reflect and helped me unwind.
With the Covid- 19 lock down everything changed quickly. Work life and home life have morphed into one and a new approach to delivering CBT and psychological support has evolved.
Prior to the lockdown, psychological interventions with clients were face to face, but the current situation has dictated that this norm no longer applies and psychology had to be delivered in a different way. We quickly adopted the use of various technical solutions including skype and zoom. I also re-assessed my role in this lockdown period concluding that as client relapse was the biggest threat at this time, then psychological support would have to be my biggest priority. I quickly ascertained that the best way of achieving this was regular and meaningful contact that would involve visual worksheets, confirmation texts and telephone/video interventions.
This has had its challenges. As clients have different psychological symptoms, and a variety of different problems, bespoke interventions are required. Worksheets for each individual client needs to be generated and this is time consuming. I started a new process of creating worksheets, posting them to clients with a request that they are read and completed prior to the telephone intervention. To ensure as good attendance as possible, I texted clients asking them to confirm the most suitable time for a telephone call. Once agreed, the telephone intervention would then take place. As the intervention is delivered by telephone, Socratic questioning and guided discovery have reduced to an extent with a larger emphasis on psycho-education.
I originally envisaged that each telephone intervention would last approximately 10-15 minutes. In reality, each telephone call is lasting 30 to 40 minutes and follows a pattern.
Some clients are isolated, some live alone and many are just glad to hear another human voice. Telephone interventions have generally been productive and helpful to the client, but difficulties have been noted. A necessary factor in aiding therapeutic change is the trust built and developed through alliance and relationship. This is a slower process on the telephone than it would be if we were face-to-face in the same room.
Since the lock down, the Substance Misuse Court team, have had to be as innovative as possible. We quickly realised the danger of people slipping back and relapsing due to Covid-19 social restrictions, but also recognised that this risk was magnified as the previous management structure of regular court appearances, drug testing and face-to-face contact was no longer in place.
We took the decision to redress this, by providing input and support to service users from as many people and sources as possible. This can be a difficult balancing act between the wish to support and the reluctance to overload. Therefore, to safeguard and ensure a balanced service delivery, Substance Misuse Court team members maintain close regular contact, sharing information about service user presentation, engagement and pertinent issues focused on within sessions.
During this period I have also been very conscious on the impact of the lockdown on staff wellbeing and mental health. I routinely telephone relevant Probation Officers and Probation Services Officers regarding service user updates, but also increasingly for a general catch up. It’s important to provide social support to each other and for us all to realise that we are all in the same boat. Some of the calls are lengthy but I think they are necessary and will help maintain and develop the individual relationships.
It’s also been important to maintain my own professional development and stay on top of changes and practice developments during this period. Recently I have sourced a number of podcasts, webinars and webcasts, covering topics such as medically unexplained symptoms, tolerating uncertainty and Acceptance and Commitment Therapy. It’s important to do all I can to anticipate changes and help develop innovative practice.
While this has been a very difficult period, I believe as a work team we will emerge stronger, more resilient and more innovative and ready to support and help hundreds of people across Northern Ireland.