For addiction counselors, working in the field of recovery can be a difficult job any year. But for those who do in-person, inpatient, and residential treatment, their jobs have been made even harder by the COVID-19 pandemic.
At the Livengrin Foundation recovery facility in Bensalem, Pennsylvania, staff have spent the past year trying to deliver services to patients while navigating new limitations and difficulties.
Taylor Willis is an inpatient counselor who started working at Livengrin in late August of 2020. The pandemic just adds another layer to an already often difficult job, they said.
“It can be hard to keep people engaged,” they said. “When they come in and they miss their families it can be something that they can point to and say, ‘I need to leave because my family’s stressed out about COVID.’”
Some patients will use the pandemic as a reason to not fully engage in their recovery, Willis said.
“It’s tough when someone maybe isn’t so sure about coming into treatment,” they said. “Some of it’s legitimate of course, but other times it can be used kind of as an excuse to not come in.”
Willis has worked in inpatient recovery for two years. Currently in the third year of a master’s program for clinical social work and human sexuality education, Willis has had a firsthand look at patients’ experiences during COVID-19.
“Treatment waits for no one,” they said. “You have to do it regardless of COVID.”
Patients at Livengrin start their experience in an isolated detox part of the facility before transitioning into inpatient rehab. Because of COVID-19, all newly admitted patients start in detox, whether actively detoxing or not, to receive COVID-19 tests and monitoring from the nursing staff.
Once COVID-19 tests come back negative, rehab patients at Livengrin are cleared to join in-person and residential activities. This means access to a wide range of professionals who all work face-to-face with patients.
Counselors meet with patients regularly during the week, either in small groups, large groups, or individually. Other staff help with everything from resolving disputes, running lectures, facilitating with activities, or simply being there to support people, both patients and other staff.
There are also other staff: a chaplain, as well as specific counselors for everything from trauma to counseling designed for military service members, cooks, nurses, financial advisers, and so on.
Before working as an inpatient counselor at Livengrin, Kelly Williams worked as an outpatient counselor at a methadone clinic in Philadelphia. The experience at Livengrin has been very different.
“I was working with people who were still using,” she said. “They would dodge me, it was very hard to have people engaged. That was a challenge trying to get people the proper level of care.”
Working with patients in rehab can feel more intense than outpatient care because inpatient counselors only see them for only four weeks, compared to working with some patients for more than a year in outpatient, Williams said.
“I originally felt like I had to solve everything in these four weeks,” she said. “But I came to realize that we just identify what they need to work on.”
Nicole Crossley, who has worked as an outpatient counselor at Livengrin for five years, was forced to do most of her work online at the start of the pandemic but now does most of her counseling in-person. Livengrin operates several outpatient facilities in addition to their inpatient facility; Crossley works in the facility at 9140 Academy Rd. in Northeast Philadelphia.
“The biggest change was going to telehealth,” she said. “It was a really big change for how we do counseling.”
She has had to adapt her counseling techniques for patients on a screen, especially for group sessions, she said.
“The dynamics are different over the internet when you can’t see a person,” Crossley said. “They’re all heads on a screen like the Brady Bunch, versus everyone being in the room, naturally being together.”
Telehealth technologies also change the interpersonal dynamics of group therapy sessions, where in-person, nonverbal communication can be very important for creating a supporting environment, Crossley said.
“People will be talking and they’ll just freeze up and they’re talking about important things, something they’ve been through,” she said. “And maybe they’ll start to cry and everyone will make faces because it’s awkward.”
Initially Crossley’s group counseling sessions were exclusively online, for about seven months. But, as COVID-19 guidelines have shifted, she now meets in-person. She facilitates a small group of about 10 people who are required to stay 6-feet apart and wear masks at all times. Even with these mandates, she believes that the benefit of in person meetings is immense.
“It’s nice to have someone be able to come online if they have to,” Crossley said. “But when it comes to addiction counseling, you want to be able to monitor someone, so that’s been challenging with telehealth.”
Isolation can exacerbate addiction, Williams said, and a big part of recovery is learning ways to avoid unhealthy isolation, a task made even more difficult by the pandemic.
“Part of recovery is being connected and using your social networks,” she said. “Going to meetings and all that was kind of abruptly taken from people.”
Though online meetings have proliferated over the past year, the connections made in in-person meetings can have a lasting impact on a person’s recovery, Williams said.
“I think that in-person definitely there’s more accountability,” she said. “And there’s something to be said about having to be in-person, having to talk to people, compared to being able to hide behind a camera.”
Crossley has facilitated hybrid group meetings, where some participants are in person and some are online if they do not feel comfortable coming in, though, she doesn’t prefer hybrid meetings.
“Doing hybrid, you can’t monitor the people as well as when you’re in the room, they might be walking away or doing the dishes,” Crossley said. “Part of [group] it is getting into a safe, quiet, non-distracting environment and making a commitment to be present, like we would in the room.”
Both Williams and Willis said they feel very safe working in-person in a residential setting because Livengrin has been very good about testing and cleaning standards. Vaccinations were encouraged and made fully available to staff there as well.
“I don’t feel at risk here,” Willis said. “I think everyone is, you know, social distancing in their personal lives, and the inpatient people I know are good about making sure because we’re coming in and out, so we don’t want to put [the patients] at risk.”
Regular testing of patients and residential staff has been the cornerstone of Livengrin’s COVID-19 plan, Williams said.
“I don’t feel unsafe because everyone is tested before they’re allowed to come in,” she said
Still, pandemic restrictions been tougher on some staff more than others
“Some people who are able to work from home are able to decide if they want to see their family,” Willis said. “They can quarantine for 14 days [before coming back to the office].”
Inpatient staff entering and exiting the facility daily don’t have this luxury though, and have had limited opportunities to see their loved one, she said. Staff who go out into the general population have to isolate themselves before they return to work, so many choose to limit the number of people they see outside of work.
“That can be very difficult,” Willis said. “I come to work because I love helping other people, but it’s tough because then I’m not able to spend as much time with my family as I would like.”
All of the counselors were in agreement that the pandemic has caused an elevation in general anxiety among patients. They’ve had to each make adjustments to their counseling style.
“COVID had kind of introduced a different kind of anxiety,” Willis said.
Crossley has also seen more intense anxiety.
“It seems like where anxiety has lessened in a lot of areas like family and relationships, there’s still a ball of anxiety when it comes to this and I think it’s taking over,” she said.
The impacts of COVID-19 anxiety will likely be felt for months or even years after the pandemic is over.
“Chronic stress, even though you adapt to it, it very much affects your nervous system and you might be operating at a higher level of anxiety but you don’t know it,” Crossley said. “Like, you’re releasing more cortisol and being a little more snappy or irritated.”
Crossley likened that anxiety of living through the pandemic to a mild depression.
“People are like, ‘Oh I don’t know why I’m sad. I don’t have reasons to be sad, everything is fine,’” she said. “Well, you’re not going on trips. You’re not going to concerts. If you do go somewhere you maybe feel a little guilty. It takes away the excitement of the options we are used to having.”
Remembering that everyone has been dealing with pandemic-anxiety has helped Crossley connect more with her patients, reminding them that, addiction aside, other people are also feeling the stresses they are feeling.
“It’s just, we’re all going through this collectively,” she said.
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Editor’s note: Our special reporting on COVID-19 may focus on communities outside Philadelphia because many of our student journalists are now temporarily located outside of the city. Instead, our reporters will cover how the coronavirus is impacting their own communities from across the country and around the world. We will return to hyperlocal coverage of Philadelphia’s neighborhoods as soon as possible.