V.V. Makarov Psychotherapeutic perspective of the COVID-19 pandemic

Psychotherapeutic perspective of the pandemic caused by the new coronavirus infection COVID-19

(Newspaper version of the lecture)

Victor Victorovich Makarov — the President of the All-Russian Professional Psychotherapeutic League and the National Self-Regulating Organization «Union of Psychotherapists and Psychologists», President elect of the Asian Federation of Psychotherapy, Vice-President of the World Council for Psychotherapy, President of IХ World congress for Psychotherapy, Head of the Department of Psychotherapy and Sexology of the Russian Medical Academy of Continuous Professional Education, MD, doctor of medical sciences, Professor. Moscow, Russia.

The lecture deals with the psychotherapeutic aspects of expecting a pandemic, the pandemic itself and rehabilitation after the pandemic. In addition, new opportunities brought by the COVID-19 revolution are examined. The development of social psychotherapy and its ever-growing role both in overcoming problems arising in society and in the development of a person, family, group and society as a whole are discussed.

What we observe today has no analogies in human history. The world is actually witnessing a world revolution, caused by the pandemic of new coronavirus infection COVID-19 (its abbreviation is the revolution COVID-19). There is a start date — March 11,2020, when the World Health Organization announced a pandemic caused by the new coronavirus.On this day the World Revolution began, setting the Age of the Newest Time on earth. The impact of such a force can only be compared to world wars and their consequences. We are well aware that revolution is destruction of the old and creation of the new.

The destruction process affected, among other things, the attitude of the authorities towards the professional community in the field of psychology and psychotherapy, when factors accompanying the pandemic in the form of quarantine and self-isolation, losing jobs and job prospects led to a pandemic of fear and anxiety among citizens for themselves and their loved ones, an increase in alcohol abuse and aggressive behavior, depression and apathy. Exhaustion and emotional burnout of doctors required the intervention of professionals of such a level and in such quantities that official medicine was unable to mobilize and provide to citizens in need of help. Doctors and other medical workers performed basic professional functions, not having the opportunity to expand their responsibilities and take care of the mental health and psychological well-being of patients.

This task was undertaken, first of all, by volunteer organizations, which began to build a system of psychological and psychotherapeutic assistance to the population and medical staff with the involvement of knowledge and experience of the professional community, including PPL members. Construction of a new system of interaction between the authorities and the professional community will not end with the pandemic, since the process of coming out of it and the rehabilitation of the citizens affected by it will require new efforts in creating an effective structure for the psychological and psychotherapeutic support of society and its citizens. We are called upon to participate in building this new structure for effective interaction between the authorities and the professional community in the most active way, dear colleagues!

Even before the pandemic was announced, even before the diagnosis of the first cases of the disease in our country, clients with phobias were already coming to us, and subsequently the number of phobias grow. The list below is far from complete.

The list of phobias associated with Coronavirus endemic:

IATROPHOBIA — fear of doctors; CLAUSTROPHOBIA — fear of confined space; SPERMOPHOBIA — fear of germs; SOCIOPHOBIA — fear of society; AGORAFOBIA — fear of public places; EREMOPHOBIA — fear of loneliness; TANATOPHOBIA — fear of death; PNIGOPHOBIA — fear of strangulation; TRIPANOPHOBIA — fear of injections; AGNOSOPHOBIA — fear of the unknown; ALGOPHOBIA — fear of pain; ANTHROPOPHOPHY — fear of people; APOCALYPSE PHOBIA — fear of the apocalypse (doomsday); AUTOPHOBIA — fear of loneliness;AEROPOLLUEREPHOBIA — fear of air pollution; AEROPHOBIA — fear of air; VACCINOPHOBIA — fear of vaccination; VESPERTILIOPHOBIA — fear of bats; WESTIFOBIA — fear of clothing; VUTEVTINDIONOPHOBIA — fear of picnics; HALOPHOBIA — fear of breathing; HAPHEPHOBIA — fear of touch (from other people); GLOBAPHOBIA — fear of globalization; HODOPHOBIA — fear of travel;GRAVAROPHOBIA — fear of bereavement; ZELOPHOBIA — fear of jealousy; INSOMNIAFOBIA — fear ofinsomnia; KEINONIFOBIA — fear of rooms; LARYNGOXEROPHOBIA — fear of dry throat; MAYEVSIOPHOBIA — fear of pregnancy; MATEROPHOBIA — fear of the mother; MOLISMOPHOBIA — fear of infections; MONITOROPHOBIA — fear of observation (from others); NEOPHARMACOPHOBIA — fear of drugs (new); NEOPHOBIA — fear of the new; NOSOCOMEPHOBIA — fear of hospitals; OBESOPHOBIA — fear of obesity; OPTAREFOBIA — fear of shopping; OHLOPHOBIA — fear of the crowd; OHHOFOBIA — fear of a vehicle (being in it); PANFOBIA — fear of everything; PARENTEPHOBIA — fear of parents; PATEROPHOBIA — fear of fathers; SIDERODROMOFOBIYA — fear of trains; STRICTUOPHOBIA — fear of stress; TAASOPHOBIA — fear of sitting in one place; TANGEREPHOBIA — fear of touching (objects); TAPHEPHOBIA — fear of burial alive; PHARMACOPHOBIA — fear of drugs; PHOBOPHOBOPHOBIA — fear of fear of phobias; PHOBOPHOBIA — fear of fear; PHONOPHOBIA — fear of conversation; THAASOPHOBIA — fear of boredom; FORISOPOMOPHOBIA — fear of door handles; PHENOPHOBIA — fear of mental illness; FRUSTRATOPHOBIA — fear of frustration; CHEROPHOBIA — fear of happiness; SCHOOLOPHOBIA — fear of school; EXAMINOPHOBIA — fear of exams; ELEVATOPHOBIA — fear of elevators; ELEUTHEROPHOBIA — fear of freedom; ERGASIOPHOBIA — fear of work; this may also include COMPUTEROPHOBIA — fear of computers; PHONEPHOBIA — fear of telephones.

There are so many fears. At the very core of these phobias is the fear of suffocation, which is not just a fear of death, but a fear of painful death. An equally common symptom of ill-being was anxiety. And if in the previous years it was more often free-floating, now alarming thoughts and experiences concerned the situations caused by a pandemic. Panic reactions were also noted. They concerned, first of all, impulsive and unjustified purchases. So in many countries people made large stocks of products and mainly toilet paper. Apparently, they unconsciously regarded its presence in the house as a symbol of stability and comfort. Moreover, many millions of people were driven out of their comfort space. The growth of both anxiety and fears as well as panic reactions were facilitated by the escalation of the situation by the media and communication. After all, bad news is always more attractive and increases the rating of the source reporting it. All this was superimposed on the uncertainty of the situation, its unpredictability, limitation of motor activity, acute reduction in social contacts. In the states where conditions for a stable life have been created for the majority of the population, where all risks are insured, people ended up being completely confused.

In our country, where there is only one stable characteristic in people's lives, which we formulate as “Everything is constantly and unpredictably changing, ” citizens seemed to be more prepared for the upcoming huge changes. Indeed, in the foreseeable past, people have never been in conditions of self-isolation prescribed to them for months, have been deprived of their usual way of life and work. The situation was complicated by the difficulties in communication, which manifested itself at subconscious level. Masks on faces give two main psychological effects: people can no longer read the person’s emotions in a mask, and a person in a mask feels more protected from other people's interest in him. At the same time breathing into a mask is meditative and even suggestive for him.

This has led to an increase in the consumption of psychologically active substances, especially alcohol, and, as a result, to family conflicts and domestic violence.

At the same time, phenomena were noted that can be assessed as positive, giving new opportunities. The families looked at each other in a new way. Spouses saw each other. Children and parents saw each other. The number of visits to antenatal clinics has increased. People began to appreciate what they had before the pandemic. Many have realized how they would like to change their lives in the future. They wished to free themselves from the shackles of the past, obsolete traditions and rules. And, most importantly, they realized how fragile our well-being and even the world order as a whole are.

What to expect in the near and distant future? In the near future, we are waiting for the problem of overcoming self-isolation. Over the past months, many people have narrowed their comfort spaces to the borders of their homes. Many lost their jobs. One can expect further growth of introversion, depression, panic disorders, addictions, divorces and new forms of structuring life, such as hikikomori in Japan. And, of course, we are expecting positive changes in the Newest Times. Thus, many peoples of our country are characterized by optimism deficit. We traditionally love to suffer. We are brought up on bans and restrictions. Modesty and striving not to stick out are welcome. All this greatly limits the possibilities for achieving noticeable results in overcoming the consequences of the pandemic and, especially, achieving state of happiness and a long tenure in this state. And what about the pandemic response? There, each state took its own measures. One thing was common to all — at the forefront of the struggle were specialists in helping professions, primarily medical workers. It is doctors who bear all the hardships of overload, conflicting instructions, and the lack of equipment with protective and consumables. In crisis conditions, medical workers are forced to narrow the boundaries of their functional responsibilities and have neither time nor competencies to care for the psychological state and mental health of their patients, even in cases where support of the mental state is recognized as an essential part of treatment and care for patients and their families. It is clear, that this is already a job for psychotherapists. And we were actively getting ready for it.

Many psychotherapists worked in their workplaces. A large number of specialists involved in psychotherapy answered the call for inclusion in the volunteer movement. Our professionals and students of psychotherapy have worked and continue working with the sick, people recovering and those who have recovered and their families. This work is supervised by the Committee for Volunteering of the Central Council of the All-Russian Professional Psychotherapeutic League (Committee Chairman I.K. Silenok). And the Central Council of our organization held International setting conferences on the methodology of this work. There have been many publications on confronting the epidemic in the media. The work being done can reduce the negative effects of a pandemic. At the same time, it is important for us to be prepared for the rehabilitation of our professionals themselves. In these conditions, we will use our special tools: Balint groups, group supervisions and personal therapy. And for those particularly affected, the debriefing procedure. For this, we have a sufficient cohort of trained professionals in the capitals and will actively prepare them for the regions of Russia.

For these purposes, we opened the Center for psychological support for employees and students on the basis of the Russian Medical Academy of Continuing Professional Education. I hope such centers will operate throughout the country.

Now about the long-term consequences of the pandemic for survivors of the disease and the entire society. Violations of psychological well-being and mental health in some patients will become protracted. This will be manifested in post-traumatic stress disorder (PTSD), prolonged depression, addictions, chronic anxiety conditions and other disorders.

Most importantly, we are experiencing a social revolution and are entering a new era, which we call the Newest Time. This era has many characteristics that our publications are dedicated to. We will name the most important of them. The main characteristic is flexibility and the ability to adjust oneself and adapt to constantly changing living conditions: for a person, family, group, society as a whole. This is the ability to live on the bright side of life, to maintain an optimistic attitude in all conditions, to strive for experiencing happiness and constant stay in the space of happiness. To achieving these goalsservessocial psychotherapy. It represents one of six models of psychotherapy. In our country it is the fourth model. Apart from it, medical, clinical and psychological models are quite developed. Social psychotherapy is psychotherapy that satisfies the social needs of a person, family, group, society as a whole.

Let us give a quote from the work of Professor Katkov A.L.: “In the field of professional psychotherapy, the new realities are such that the pace, scale of distribution and severity of the manifestations of the problems with which clients turn to specialist psychotherapists (adaptation disorders in all their diversity, chemical and destructive psychological dependencies, personality disorders, long-term psychosomatic and mental illnesses, etc.), in the most recent decades, they have become destructive social epidemics — apparently the most dangerous and unpredictable phenomenon of modern times. Accordingly, if the term “social psychotherapy” has traditionally been applied only to certain psychotherapeutic models, we propose to use this term to denote the new status of professional psychotherapy that fully meets the realities of modern times. This is a cardinal turn of the profession from exclusive or “club” models with an extremely limited sector of interaction with neurotic clients to completely new conceptual and organizational models of the “being” of professional psychotherapy in the modern world. Which, ultimately, should lead to full coverage of the population with effective, differentiated psychotherapeutic help» (2019).

We have been engaged in social psychotherapy since eighties of the last century. This model of psychotherapy was formed within the framework of the Eastern trend in the development of Soviet and Russian psychotherapy. It formed the basis of a new, broad school of domestic psychotherapy.

The birth date of world social psychotherapy can be considered the summer of 2002, when at the III World Congress of Psychotherapy the president of the World Psychotherapy Council called on psychotherapists to work with the whole society, and not just with a person, family and group. Our League is being developed under this motto. Most of our 50 modalities are already functioning in the field of social psychotherapy. Приведём их список:

• Hypnotherapy
• Person-oriented (reconstructive) psychotherapy
• Polimodal Psychotherapy®
• Systemic family psychotherapy
• Existential psychotherapy
• Gestalt therapy
• Body-oriented psychotherapy
• Resource-oriented systemic psychotherapy
• Positive psychotherapy
• Symboldrama
• Transpersonal psychotherapy
• Neuro-linguistic psychotherapy
• Therapy with creative self-expression M.E. Burno
• Psychocatalysis
• Clinical classical psychotherapy
• Dialysis
• Psychodrama
• Emotionally-shaped psychotherapy
• Psychoorganic analysis
• Transactional analysis
• Psychotherapeutic kinesiology
• Erickson psychotherapy and Erickson hypnosis
• Perinatal and reproductive psychotherapy
• Religiously oriented psychotherapy
• Musical-integral psychotherapy
• Clinical psychosomatic psychotherapy
• Healing creative psycholinguistics
• Cognitive-behavioral psychotherapy
• Client-centered psychotherapy
• Integrative dialogue, cognitive-oriented hypnotherapy (psychotherapy)
• Art Therapy
• Jungian analysis
• Joint psychoanalytic approach in psychotherapy at the League
• Balint groups
• Integrative child psychotherapy
• Systemic family therapy: eastern version
• Eastern version of transactional analysis
• Integrated neuroprogramming
• Systemic-phenomenological psychotherapy (counseling) and client-centered constellations®
• Ethical personalism
• Process-oriented psychology and psychotherapy
• Generative psychotherapy
• Eastern version of psychosynthesis
• Sand therapy
• Rodological counseling method
• Group analysis
• Behavioral psychotherapy
• Value-oriented psychology and psychotherapy
• Sofia analysis
• Game practice in therapy and psychological counseling (psychotherapy cluster)

Thus, modern social psychotherapy has found its important place both during the fight against the pandemiccaused by the new coronavirus infection COVID-19, and in the lives of people, families, groups, the whole society in the newest era.