Counseling the Counselors amid Covid-19

The coronavirus lockdown in March plunged Sri Lankans into a period of confusion and stress. Like people around the world, they were suddenly locked into a 24-hour cycle of bad news, grappling with fears of job loss and infection, learning to live with the aggravation of cooped-up families, and searching for new ways to meet basic needs. It’s been a difficult time for everyone, but perhaps uniquely so for the teams of psychosocial counselors attached to the Ministry of Women and Child Affairs and the Ministry of Social Services, who are working hard to help anxious Sri Lankans with their burdens even as they bear their own.

Introduced into government as a part of the Mental Health Policy of Sri Lanka 2005–2015, these mental health professionals were already juggling the multiple roles of counselor, social worker, and aid worker. Now, as Sri Lanka faces the crisis of Covid-19, they find themselves helping a growing crush of counseling patients to navigate the stress and uncertainty of a global pandemic while also managing food rations and cash relief payments—all while working to implement new and unfamiliar online counseling systems. As mental health professionals in a time of community crisis, they are expected to have the strength to help others even when they are themselves vulnerable and uncertain.

Sri Lanka’s national counseling service is facing a growing crush of patients trying to navigate the stress and uncertainty of the global pandemic.

A mapping study by the two ministries and The Asia Foundation’s Mental Health and Psychosocial Support unit (MHPSS) in 2015, and a second two years later, found that these state counselors mostly see clients with social or family problems rather than psychiatric issues or mental disorders. Months of island-wide lockdown have made these problems worse, amplifying behaviors like substance abuse and gender-based violence while making it far more difficult to deliver mental health services.

Many of the problems that clients bring to counselors, especially now, during the pandemic, are related to the struggles of daily life, problems that often go beyond the normal scope of counseling. Many are now fundamentally suffering from poverty, for example. A counselor may be able to encourage them with their work ethic or refer them for other services, but poverty is a systemic issue that counseling can’t really solve.

Everyone is exhausted, and the counselors will have to do a ‘big counseling program for the entire community’ when all this is over.

Yet clients and communities still expect a “cure,” and they continue to come to counselors with problems of all kinds. “Clients haven’t received their government food rations, or they haven’t received their psychiatric drugs. The grama niladari [village officers] say everyone is exhausted and the counselors will have to do a ‘big counseling program for the entire community’ when all this is over,” said one counselor from the North Western Province. Meanwhile, the parent ministries lack the expertise to guide counselors perplexed and frustrated by these tangled psychosocial problems, to train them in the techniques and technology of remote counseling, or to support them when the stresses of the pandemic begin to affect their own well-being.

Even before the psychosocial impact of the pandemic became a reality, The Asia Foundation was piloting a program to provide professional support and supervision of counselors’ practices in two locations on the island. In many countries, clinical supervision or mandatory therapy sessions for mental health professionals are common. In Sri Lanka, however, support systems for state counselors, to provide guidance and ensure that they have somewhere to turn when the job gets overwhelming, didn’t exist. While the Foundation helped set up a peer-support mechanism in 2015 to give counselors a safe space to meet every month in small groups and discuss difficult cases among themselves, counselors had never received expert supervision of their practices from senior professionals in their field on matters directly related to their work.

With conceptual guidance provided by a team of technical experts, 50 counselors from the Eastern and North Western Provinces now meet in small groups every month to engage in a modified peer-support process in the presence of a supervisor. The supervisors help the groups achieve a sense of safety to reflect on their work with clients and the impact it has on themselves, to confront their own biases and beliefs, and to untangle knotty cases by sharing them with their peers.

Reflecting on almost a year of implementation, the technical team has now put together a collection of articles on the nuts and bolts of setting up a practice-supervision system in an Asian context. Piloting Practice Supervision for the Government Counseling Cadre: Lessons and Reflections from Two Pilot Locations in Sri Lanka will be released to the public on September 23, 2020. The articles, contributed by the technical team, the practice supervisors, and the counselors themselves, discuss the sociocultural, political, and administrative challenges that these counselors face in their work, as well as the nuances and ethical implications of the practice-supervision process.

One supervisor reported that one-on-one sessions with the counselors were quite effective:

As counselors, they felt they had to present themselves to the world as strong and competent professionals devoid of vulnerabilities. They carried their burdens silently and rarely found someone with whom they could share their difficulties without fear of judgment. A majority of them expressed great relief after their individual sessions and declared that this was just what they needed.

The publication also provides a unique view of the world through the eyes of the counselors—their work, the problems their clients are struggling with, and the expectations of their communities—offering a compelling portrait of the complexities of their role in this difficult time.

Read the full report, Piloting Practice Supervision for the Government Counseling Cadre: Lessons and Reflections from Two Pilot Locations in Sri Lanka.

Mihiri Ferdinando is the director of the Asia Foundation’s Mental Health and Psychosocial Support program in Sri Lanka, and Kaushi Jayawardena is an MHPSS program officer. They can be reached at [email protected] and [email protected], respectively. The views and opinions expressed here are those of the authors, not those of The Asia Foundation.