Apr 28, 2020 7:00 AM

The Pandemic Creates New Challenges for Crisis Counselors

Therapists and hotline workers who work with abuse victims now must take calls from home, increasing their risk for isolation and emotional burnout.

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Shelter-in-place orders have confined as many as 300 million people in the US to their homes since March. Staying indoors may make someone less likely to contract Covid-19, but for many people, home is not a safe place.

Counselors, therapists, and hotline workers involved in crisis support say many people are made vulnerable by the very orders meant to protect them. Call centers have closed their doors temporarily, requiring workers to field hours of emotionally intense calls from makeshift home offices. Their clients, many of whom must “shelter” with abusers, have had to become more discreet, reaching out in brief moments of freedom, sometimes in whispered tones.

“Where they usually have eight or nine hours a day of freedom and peace, they now have their partner there with them 24 hours a day,” says Richard Ham, a program services manager at the National Domestic Violence Hotline. “So that little bit of space for self care is not existent anymore.”

Ham says calls to the hotline haven't increased since the orders began. He suspects this may be because victims have less time to themselves. This relative lull could, he fears, lead to a boom once shelter-in-place orders are rescinded.

“What we tend to see with moments like this is that after this is over, then we get all the calls saying all the things that were taking place during this time,” he says, noting a similar dynamic during long holidays.

Home confinement is also shifting how counselors provide services, with many already feeling the pressure as their work collides with their personal life.

Erika Brosig is a clinical director for Victim Services, a Pennsylvania nonprofit helping victims of sexual assault. Since the offices closed, she’s been working from her bedroom.

“There's so much about this that's familiar to survivors,” she says. Weeks of shelter-in-place orders can trigger an “oppressive feeling of being trapped in their house and being unable to leave” for victims, whose daily lives are uprooted by the order.

Counselors must also contend with isolation and the blending of their work and personal lives. “I have to shift, at the end of the night, back to being mom and wife rather than therapist and crisis counselor,” she says. “But there's no closing the office door and walking away. It's stepping from behind the desk and into the rest of the bedroom.”

These counselors are aware of the psychological dangers of our new normal but are also vulnerable to the same malaise affecting others being forced to work remotely.

“Someone who does counseling or therapy all day long, they're hearing the really hard stories that people are living through,” explains Ali Perrotto, who runs the Sexual Assault Resource and Counseling Center in rural Pennsylvania. “Over time, they might start to have their own experiences of nightmares, or something like that, related to a story they heard that day.”

This “vicarious trauma,” as Perrotto terms it, can be psychologically damaging to counselors. Internalizing this trauma is always an occupational hazard but is especially heightened now that so many counselors work from home.

Remote workers are at increased risk for isolation and burnout. Crisis centers usually have regular team meetings to prevent vicarious trauma. These have gone online as well, as workers discuss difficult calls and try to maintain community over apps like Zoom and Houseparty.

“A lot of times [counselors] just need somebody to listen, which is a really big principle in the work that we do,” says Danielle Ehsanipour, director of Lifeline for the Trevor Project, a nonprofit focusing on suicide prevention efforts for LGBT youth. The organization shifted to remote work last month. “There’s an interactive component and opportunity for feedback, too. We really like those debrief sessions to be collaborative.”

Some components of crisis service can be recalibrated for the new remote world, but not one: accompaniment. Advocates work with survivors of domestic violence and sexual violence as they navigate a complex world of hospitals, police departments, and courtrooms, traveling alongside them for hearings to petition for a restraining order, for example or, for medical exams.

In the aftermath of an assault, specially trained forensic examiners collect biological evidence from victims. This process takes hours. Examiners collect blood, semen, hair, and urine samples. They collect DNA from their hair and under their nails and take photos of their wounds.

As a cautionary measure, Brosig says, many hospitals are now restricting access to exam rooms to only family members. Her team offers remote support via phone calls, but talks of offering telecounseling during exams are “just starting,” she says; both hospitals and victims would need to agree.

“It's not something that we'll be diving into until we know more about how long this is going to last,” she says. “From what we're hearing, this is likely to come in waves. So this time, we didn't have that in place. But for next time, you know, maybe that's something that we'll be doing.”

Brosig knows teleconferencing is a very uneasy measure to even suggest but says there are few alternatives as the pandemic forces survivors to face such challenges alone.

“It's completely unprecedented that we’re having these conversations,” Brosig says. “You just never think you would ever be in this position. And here we are.”