Now that face masks are being recommended for professionals in every care setting, (as well as for citizens on the street), I’ve heard from nurses and other care partners how frustrating it is to be unable to smile at the people they are working with and caring for. They worry that a vital component of the connection they strive to make with the people they serve is being compromised.

We also have to ask ourselves what it’s like to be the person accepting care in the era of the covid-19 coronavirus.

As health care providers, we need to be aware that people who live with a trauma history may be triggered by face masks in ways they may not even comprehend on a conscious level. I’m thinking of two primary kinds of trauma right now, although there may be others:

  • Face masks and other personal protective equipment (PPE) may be painful reminders of past medical procedures
  • Face masks may be subtle triggers for past relationships where needs for nurturing were not met.

Let’s start with the first instance, as medical trauma is common. The trappings of a “hospital” setting, such as gowns, gloves, and face masks, now appearing in the home or nursing home setting, can be potent reminders of past illness, injury, or loss.

Some of this trauma may be held in the body, some in the emotions, and some in the thinking part of the brain.

Millie was only four years old when she had her tonsils out. She remembers being dropped off at the hospital by her parents, but can’t recall that they ever explained why she was taken there, or why they left her there, alone and afraid. When she tells the story about this first experience with a hospital, she recalls her feelings of fear, and being surrounded by strangers in masks. Her heart actually starts to beat faster as she recalls what happened to her, and she experiences a sense of tightness in her chest and throat. From the time she was a little girl, Millie has disliked hospital settings, and she becomes extremely anxious when she or a family member has to have a medical test or procedure.

Human beings are born into this world seeking connection. We need to know that the people around us are safe and nurturing, and we are assured of this from the physical cues we get from them, including loving smiles, gentle touch, and soft words.

This need is so fundamental, we know that children who don’t get consistent connection and interaction from their caregivers can suffer from physical, cognitive, and emotional problems across the lifespan. They can even die from a lack of nurturing from what has been called “failure to thrive.”

Dr. Ed Tronick demonstrates the vitality of face-to-face connection in a video of his “Still Face Experiments.” I urge you to watch this brief video, as it helps us instantly grasp the impact of a lack of caregiver feedback and nurturance on infants. The loss of warm connection isn’t always about abuse: a grieving, ill, seriously depressed, or chronically intoxicated caregiver might have difficulty giving a child what they need to feel safe in the world, and secure in themselves.

The impact of this early disconnection can last a lifetime. As a psychotherapist specializing in trauma in Elders, I’ve experienced how even tiny changes in facial expression are detected by people who may have been neglected or abused as children.

This ability develops as a survival skill for the child, but doesn’t always serve us well in adulthood. “Micro-expressions” are most often interpreted through the lens of our own experience and beliefs, and can be false readings in the present moment. We may tell ourselves that we are not safe, are unworthy, are disliked, or are being disrespected when we believe we detect a frown, a smirk, or a furrowed brow. The result may be a feeling of rejection and shame, loss of trust, and disrupted relationships.

Now imagine that you are a health care provider in the era of covid-19, approaching those you care for while wearing a face mask. Of course you are protecting yourself and them from a particularly contagious virus, but how can you bridge any perceived break-down in connection the mask (or other PPE) may create?

How to bridge the emotional distance created by wearing a face mask:

  • Be aware of your own reactions to the PPE

Before you see the person accepting care, do some thinking about how wearing PPE actually feels to you. How do you usually connect with the people you serve? How might your new appearance and physical stance change the interaction? What emotions, physical feelings, and thoughts do these changes this raise for you?

  • Get centered

Just before the visit, take a moment to clear your mind of everything but the person you are about to visit. Take a few deep breaths, and calm yourself, bringing your attention to the present moment. Release any tension you feel in your muscles. Feel your feet as they connect with the ground. Exhale deeply!

  • Acknowledge the presence of the face mask, and explain why you’re wearing it

This may seem too obvious, but mentioning that you’re wearing a mask and other PPE, such as gloves, grants the other person permission to ask questions and talk about their concerns. For example, it will be important to say that you are wearing PPE for all of your visits, to protect everyone else as well as to protect yourself. Some people may assume that you are afraid of “catching something” from them, or that they are sick and haven’t been told. (Please remember, the oldest people you see were raised in an era when patients were not always informed about terminal diagnoses).

  • Ask what questions the person has about the mask or other PPE

Assure the person that any and all questions are welcomed, and answer them as honestly as you can. If you don’t know the answer, tell them so and agree to try to find more information or refer them to the proper resource. The information about covid-19 coronavirus is changing rapidly and we are learning every day; it’s important to reinforce the idea that we are all in this together.

  • Ask about the impact on the person accepting care

In a situation where you’re offering care to someone you know, you might simply ask: “What is it like for you to see me wearing a mask today?”

They might say something like, “I really miss seeing your smile,” or, “it’s hard to know if you’re having a good day, or if you’re mad at me.” They may also say they appreciate that you are being careful with their health!

This can be the start of a good conversation about what is meaningful to the other person about the relationship you share.

  • Invite the person to partner with you to create solutions

Build on what you’ve learned from this dialog, and ask what can be done to compensate if there is a negative impact of the mask. For example, if the person says she misses seeing your smile, ask how you might let them know you are smiling at them. Stay open here – you never know what wonderful creativity will come from this question! Most often, having opened the doors to the issue by raising it directly will be enough to relieve any tension. Be sure to invite any and all questions, at any time.

  • Thank them for being willing to have this conversation

Express your appreciation for their help in working through the new challenge of wearing PPE in relatively routine care scenarios.

  • Be vulnerable and real, but keep the focus on what the person you’re caring for needs

It’s okay to share your own feelings about PPE here, but please be brief, and avoid going into your own specific fears about the covid-19 pandemic. The people who accept care from you are concerned about you and will worry if they have a picture of your specific situation; you are a key part of the support system for them, and your own supports will have to be outside of the relationship with those you care for.

  • Be aware of mental health resources for yourself and those you work with

This is a highly stressful time for both health care providers and people accepting care. In some care settings, social workers and other mental health staff have been sent home, just as every member of the care partner team may need extra support.

Many of us in the mental health field are offering online support in the form of counseling and support groups, and insurance companies are loosening regulations to make such resources available to our providers and Elders alike. Check with your organization, Employee Assistance Program, union, or health insurance provider as a start.

The world is waking up to the heroic work our health care partners do every day, and there is not enough gratitude to express the appreciation we all feel for the women and men at the front lines of care.

Thank you for all you do, and please take care.

What would you add to this list? What have your experiences been in either giving or receiving care while wearing PPE? I’d love to hear your comments.


Lisa Kendall has worked with Elders and their care partners for over 40 years in a variety of care settings, and recently retired from her private psychotherapy practice where she specialized in trauma, health issues, grief, and loss. Lisa is an Educator and Mentor for The Eden Alternative, and continues to provide online education for individuals and organizations striving to support well-being for the entire care partner team. You can read her blog at www.lisakendallcounseling.com/blog


Information from the CDC on Stress and Coping during the Coronavirus Pandemic:


Mental Health and Covid-19 Information and Resources from the Mental Health Association:


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