Confronting someone with depression

When on February 24 Tatyana Ivanova (the heroine asked to change her name for the text) learned that the war had begun, she "had the feeling that an urgent teleportation to hell had begun": "I had a feeling that this was the end, disappointment in everything, and at the same time rage and the desire to break something.

She has been seeing a psychologist once a week since July 2021 due to childhood abuse and complex post-traumatic stress disorder (CPTSD).

Tatyana is not an activist or a journalist, she works in the field of consulting and follows the news agenda through independent media. “At the sessions, we started discussing Ukraine even before the hostilities, because it was clear where everything was heading. After February 24, we only talked about this,” Tatyana told the BBC. nine0003

Their session a week after the start of the war began with a standard specialist question: "How was your week?" Tatyana, in response, said that she was very worried about what was happening: “The psychologist clarified why I was so worried about this. I explained that it seemed to me a disaster for Ukraine, Russia and the whole world in general, and I all this pain."

Ivanova recalls that in the first three or four days of the war, she and her friends were very active: “We went to protest. On the second day of the war, I stayed overnight with a friend and we made sticker layouts. to keep in touch with as many people as possible. But on the fourth day I broke down. And everyone around me too. My friends and I fell straight into depression. Since then, I have hardly met any of them." nine0003

"It makes no sense to try"

The war could not but affect the mental state of the Russians. Even the state sociological service VTsIOM recorded among respondents an increase in anxiety (on February 3, 41% of respondents experienced such emotions, and on February 27 - already 56%), fear (on February 3 - 18%, on February 27 - 28%), confusion (on February 3 - on February 22 %, February 27 - 27%). Psychologists, psychotherapists and psychiatrists have faced a large number of requests for consultations. But not all of them were ready to work in a crisis situation. nine0003

The war in Ukraine "changed the life in many ways" of Nadezhda Zakharova. At the end of 2021, she was in one of the psychiatric hospitals in Moscow "because of apathy, anxiety and suicidal thoughts." After that, Nadezhda periodically went to a psychiatrist at a state hospital to find a treatment regimen and get prescriptions for medicines.

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After the outbreak of the war, the neighbor with whom Nadezhda rented an apartment moved to another country for work. Zakharova did not have enough money to pay for an apartment alone, and she was forced to return to her hometown and live with her mother, although "I did not want to return at all."

There is only one neuropsychiatric dispensary (PND) in Nadezhda's hometown, and it takes an hour to get there. Therefore, "it is unlikely that I will be able to use free healthcare in my hometown," says Nadezhda. She cannot afford paid sessions with a psychiatrist. nine0003

According to Zakharova, thanks to the pills given to her by a psychiatrist at the state hospital, she is "getting better - her apathy is not as strong as before", and she can already "do something": "But maybe I have psychosis may soon begin, because it is very difficult to endure what is happening - I am torn between anger and impotence.

Nadezhda feels "complete despair" when she thinks that she "will not be able to get out of here", that she "will always live as badly as she lives now, if not worse", or when she sees that "it is real a lot of people who support all this and have no empathy." "It worsens your condition, because you understand that it makes no sense to try to do something better in this country," explains Zakharova. nine0003

• Do Russians support the war in Ukraine? Depending on how to ask

"There is a war and people are dying"

Dmitry Stebakov, a clinical psychologist who has been advising NGOs, human rights activists and journalists for the last seven years, says that in the first two weeks of the war "there was a wave of requests for crisis consultations", and he had to work 10-12 hours a day: “Indeed, the war and its consequences affected people very much. In the early days of the war, my clients who contacted me (journalists and human rights activists make up only half of them) experienced an acute stress reaction , and their requests were about how to extinguish these states - someone had the highest anxiety, someone had panic attacks, someone was in prostration and tried to collect himself. nine0003

Nadezhda Zakharova recalls that against the backdrop of the war, she developed "very strong near-panic anxiety, because it is not clear what will happen next, what the consequences will be, where to run, because I don't want to be locked in this country, given the current conditions" .

According to Stebakov, one of the first verbal reactions of many clients is: "There is war and people are dying, but here we are losing our future." Gestalt therapist (Gestalt is one of the directions in psychotherapy - approx. BBC) Tatyana Lebedeva adds that anxiety can be felt "not only because of the vague future, but also the loss of work or fear that this may happen in the future , and also because of the difficulties in communicating with loved ones or adapting to life in a new country. nine0003

Now "the situation has stabilized a little, and this also corresponds to how we experience acute stress," explains Dmitry Stebakov. "People have slowly begun to adapt to life outside of long-term planning, outside of the future, but the planning horizon is still expanding a little. The tone of requests has changed - now clients are increasingly coming with topics that concern a person personally - someone has a sudden evacuation in life, someone is trying to stabilize life and continue to work," Stebakov said in a conversation with the BBC. nine0003

"It was a shock - both personal and professional"

Gestalt therapist Tatyana Lebedeva says that "many psychologists were not ready for what happened:" On February 24, we had a supervisory group (a meeting at which psychotherapists receive feedback from a mentor) and it was possible to notice that colleagues had a misunderstanding of how to deal with this. It was a shock - both personal and professional. When the first wave of shock passed, it became clear that a lot of people would need psychological help.”

According to Tatyana, the professional community quickly responded to the request, and, for example, her Facebook feed, which consists mainly of colleagues, turned into a learning platform: "We all sent interesting articles to each other, because a dumb question, how to work with it, all the same emerged.It's one thing when you, as a professional, face grief - it's clear how to work with grief, but for such a shock situation, from which you yourself are in shock and lose confidence yourself, you need to find some it's new ways of working." nine0003

"My colleagues and I discussed that all of a sudden everyone became crisis psychologists, because the situation forced them. , to which I am related, held and recorded a seminar on the use of our method in crisis counseling - everyone shared what they could. Colleagues from the European Association for Brief Therapy recorded words of support and are planning to make a series of webinars for our audience, "says Stebakov. nine0003

Lebedeva says that colleagues shared with each other, for example, protocols for first psychological aid. One of them was the RAPID protocol, designed to work with people who have experienced severe shock.

The RAPID Psychological First Aid Model was developed on the faculty of Johns Hopkins University by George Everly Jr. This model has been used in the emergency assistance system since 1991 in the Red Cross system. It aims to reduce the general level of stress in victims and assess the need for further assistance. nine0003

"This protocol is a kind of cheat sheet that tells how to remove the shock situation and draw the person's attention to himself: what is happening to him now, what his needs are, and so on," explains the Gestalt therapist.

Tatyana Ivanova recalls that in response to the experiences she described about the war in Ukraine, the psychologist explained to her that "taking care of yourself is not a shame, and feeling everything around you can eventually have a bad effect on her. " But Ivanova says that she cannot refuse this, since "to be indifferent" is "an unacceptable thing" for her. nine0003

"Clarified her position in social networks"

The large number of requests for help is not the only problem that psychologists and psychotherapists faced after the start of the war in Ukraine. Gestalt therapist Elena Moskaleva told the BBC that "there are a lot of stories in the professional community about how clients and psychotherapists differ in values ​​and views."

Elena says that "we live in a time when everything is transparent - therapists have social networks, clients come to them through social networks, the intersection of civic positions with therapeutic positions is inevitable, and clients can ask questions about this": "War dictates a choice to us polarities, so it is especially important to find a way out of these polarities in the therapist's office." nine0003

The author of the photo, Empics

Moskaleva also "clearly outlined her position in social networks" - she, as a professional, worries that "there are people who attack, there are people who are victims. " But she admits that her personal history also influences her - Elena was born in Mariupol. Now she is a volunteer in the movement of psychotherapists helping victims of the war.

Elena talks about ending therapy with a client she worked with for several years due to different views on what is happening: "After she found out about my position, which I express quite openly on social networks, this became a stumbling block for her , and she made the decision to end therapy because she doesn't agree with my attitude towards the war, that this is a war." nine0003

According to Moskaleva, she managed to part with the client “humanly”: “As a therapist, it was important for me to support the client’s choice and not lead her somewhere she doesn’t want, because it’s not my task to change a person. The task is to help on request.

At the same time, Elena still believes that “clients need to be broadcast that violence and war are bad, and it is important to live collective feelings not only when you are proud that our athletes won medals (and then the collective feeling is experienced easily), but when a collective sense of guilt is lived, it is important to touch it": "It makes us empathic, and this is at the heart of any therapeutic process, regardless of what problem a person came with, because if he comes into long-term therapy, he comes also for the development of awareness and empathy. nine0003

• Violence as a means of warfare. What is known about rapes in the war in Ukraine and how they are investigated

Moskaleva says that she does not know about cases when a therapist refused a client because of different political positions, because a specialist does not have the right to do so. But she admits that when the therapist realizes that he is "in the midst of his own trauma," he may, for example, take a break from work.

"When experiencing anxiety, a psychologist can work with a person who is experiencing anxiety"

According to gestalt therapist Tatyana Lebedeva, it cannot be said that she herself completely accepted this situation, and she is not sure that she will ever be able to accept it: "Rather, I found some kind of support for myself that helps me to stay in touch with reality and do what I have to do."

Dmitry Stebakov also admits that, like his clients, after the news of the war, he "experienced anxiety, a feeling of acute stress and a loss of vision of the future. " "The war started when I was supposed to be training for groups and it was necessary that working with these groups would be beneficial. As early as February 24, I had a personal session with my therapist and spent quite a lot of energy getting my boundaries in order, so that it does not interfere with working with people who react sharply to what is happening," explains Stebakov. nine0003

Lebedeva says that, ideally, a psychologist should demonstrate stability and not join the client's state of shock, but one of the techniques, on the contrary, suggests that the specialist will say: "You know, I'm also in shock." "An important note is that not all clients can be told this, and not all clients need to be told this, but this kind of legalization of feelings takes away their intensity and helps clients know that they are not alone in this or are not alone in feeling it."

According to Stebakov, there are different states of the psychologist himself - those that can interfere with adequate work, and those that do not interfere: "When experiences penetrate work with a client and anxiety prevents you from concentrating, leading a session, asking questions and doing practice - this is a reason to take care of your condition - go to your therapist, supervisor.

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