As the coronavirus has developed over the course of the past months, weeks, and days, our plans have changed and so have our lives. And it appears this will be the norm for a while. In this series (duration: a few weeks to…not sure?), we’ll share the stories of people who have confronted the unexpected in interesting ways. Today, we have five therapists who are adjusting to the new circumstances and universally-shared anxieties in their line of work.
The pandemic is remodeling our society like it’s clay spinning on the axis of a pottery wheel. For some, speaking with a therapist is the most familiar method for interpreting our experiences and surroundings, and for internalizing an understanding of our new, malleable world. That’s why the question of what it’s like to be a therapist right now has been boomeranging around my head lately. How does it work, as they manage other people’s feelings on top of their own? Are they more in-demand than usual or less? How have their routines changed—and how has the logistical adjustment to working remote been? As a therapist, do you ever prepare for or fear for this kind of global calamity? Seeking answers, comfort, and different points of view, I asked a few therapists about what work is like during these very singular days.
On becoming more resilient
My routine has changed significantly. After being at a hectic group practice in SoHo for years, I just opened my own beautiful, peaceful little office in Chinatown. On March 12. So sad. I had just a handful of sessions there before I had to close up shop and start doing video sessions from home. My people are mostly millennials and have adapted to the logistics and the app I use, Doxy, pretty seamlessly. I’ve actually had a few patients quit because they are in theater and music and hospitality, and they’ve lost their income. Artists have been hit incredibly hard. I’m offering a sliding scale rate for people who really need it.
It’s interesting maintaining relationships that used to be in person via video sessions. There is some information you don’t get this way (“Why is she carrying seven bags?” “How did she walk here in those shoes?” “Was she flirting with that other guy in the waiting room?”), but I think video sessions work because the visual helps with emotional regulation. It’s interesting to see patients in their homes, too. It’s an intimate experience, being more up-close and personal. It’s such a 21st-century, contrived set-up that I think to compensate, I am probably less formal and more warm than I’ve ever been in the room.
One thing that seems to be resonating with people in pandemic life is talking about mindfulness and how we can bring ourselves back to the present moment, when things feel really catastrophic and terrifying. In this moment, you are OK. We also talk about self-care and routine and the things you can do to send your body the signal that it’s safe. I’m a former health coach, so we talk about drugs and food and sleep and exercise as well. I keep people accountable for those things. I believe wholeheartedly in the power of exercise and meditation. They make you more resilient, which is exactly what we need right now. —Ann Farrar
On calming the nervous system
I am comforted by my own belief that things will not always be this way, and that while there will be plenty to grieve, there will also be surprising outcomes that will benefit the lot of us. So I heed my own advice because I deeply believe it, and of course, saying it over and over again to my patients helps to solidify it in my own mind.
Many patients are settling into the routine, and while we’re all experiencing the loss of physically being together, I’ve found my patients to be resilient and resourceful. Some use the phone, and lie on their bed or couch, and that has actually worked to move the sessions forward in much deeper ways. Others prefer video, and will wear headphones so that the therapist is heard in surround-sound, which can feel intrusive to some but calming to others. All of the information that comes out of this new normal is clinically useful in helping me to understand my patient’s inner world.
For the first few weeks of my sessions, much of my attention was spent supporting my patients in keeping some semblance of a schedule. When our external structures are so abruptly disrupted, our internal psychological organization becomes fragmented as well, and we can feel trapped or helpless. It is precisely the feeling of helplessness that amounts to trauma, so reminding ourselves that we do have some agency around how we organize our day is often the antidote. I have to make a strong case for implementing structure at a time when people are in survival mode: to set your alarm for the same time every day, shower, get dressed, make your bed, meditate, exercise, and eat well. Reminding my patients that our bodies, and specifically our nervous systems, can easily become dysregulated such that we are almost tricked into thinking we are in a default anxious flight-or-flight mode is no easy task, as we all fall victim to that familiar trope of “mind over matter.” But calming one’s nervous system with deep breathing, exercise, and structure will first register in the physical body, paving the way so that our minds can follow suit. Without the calming of the physical, our minds will continue to be trapped in the anxious state.
One of the most resounding and effective arguments I can make for this case is to remind patients that when children are dysregulated, either through a frightening, fearful, or stressful event, what is most effective in calming them is making them feel their bodies are safe. As parents or educators, we will soothe children in this frightened state by hugging or holding them, by speaking to them in soft, calming voices, or by giving that nervous energy a chance to discharge through movement. Only once we calm children down, can we then address their emotional state. It is the same for adults, so attention must be paid to the body first and foremost. —Yuen Chan
On the clarifying feeling of fear
What I do for a living is a privilege and I love working with my clients, so even though I’ve been practicing for about 30 years, listening to what people are going through has never felt even remotely burdensome. But these past few weeks I’ve noticed I’ve needed the weekends to restore my balance. I think it’s because with my entire caseload affected by the same thing, my listening has accumulated layers and layers of similar concerns—and those layers were adding to what my family, friends, and I were all feeling as well. I’ve tried to be more conscientious about making sure I do my best to start each week with as much fresh space for session content as I can.
I feel incredibly lucky that my 24-year-old daughter and her boyfriend are quarantined with me and are able to work remotely. Having an adult child back in the home for an indefinite amount of time? Heaven. We’re cooking together and having leisurely dinners—ohmygod I’m LOVING it.
On one level, there’s the sense we’re all going through this together—we’re human among humans—and are all anxious and frightened by the uncertainty of how the impact of it will reverberate in our lives. On another level, it’s bringing up the private and unique experiences of what each client has experienced in their life to date. It’s triggering and spiking familiar feelings of whatever was already there: loss, depression, anxiety, troubled family dynamics, etc.
›So for example, one person who, in the past, lost a loved one and has already lived with grief might worry about losing someone to the virus. Another who had a period of depression in the past might be unnerved by quarantining because it feels like their depression has come back, since the signifiers are the same—not wanting to leave the house, spending more time in bed, spending more time in pajamas, feeling isolated. The reason for staying home is different now because it’s driven solely by the virus, but emotionally it might evoke a different kind of suffering from the past.
When the virus made its way here, it demanded our attention, and our basic response to it has been fear. But it’s usually when we’re the most afraid that we’re also most aware of what’s important to us. It’s a time we feel with great clarity who we love. Our fear highlights who and what we want to protect, and that is a gift this pandemic is giving us. Tell the people you love that you love them. And, when this pandemic has run its course, remember not to take for granted the things from your “normal” life that you may be missing right now. —Joyce McFadden
On limiting media intake
It’s really interesting dealing with and coping with many of the same things my clients are experiencing. We are all navigating through uncertainty, fear, loss, and in many cases, we are consuming similar media. At times I am right there, in the depths of it all, and I have to rely heavily on my training to show up fully. They need me right now.
My routine hasn’t changed much. I live upstate on a farm and come into the city a few times a week to see clients. Most of my practice was already teletherapy. My clients are grateful that they were accustomed to video-only sessions. I feel for those who didn’t really have the choice—it’s disconcerting to have that choice taken from them, and it only contributes to the feeling of powerlessness. I hope people see the value of teletherapy and that more people become open to it. Because I have lower overhead, I cut my fee by 40% for video clients. It also allows me to see more people on a sliding scale—that way I’m able to accommodate clients who can’t find in-network therapists.
I have been telling my clients to drastically reduce news intake and to create hard boundaries around social media as well. It’s something almost all of my clients struggle with anyway. Now, more than ever, I am suggesting that folks sign up for specific alerts, delete Twitter, and unfollow/mute anyone that doesn’t bring them joy. —Raven Burgos
My population, predominantly women ages 18-30, are going through the transitions of first and second jobs, relationships, moving and building community that supports adult life outside of college. Their obstacles are important and familiar. I have personal experience facing those challenges, so I can relate and be compassionate. The difference is that they are not my current challenges—current empty nester, downsizing home, aging parents—so I can usually leave my work at the office. Now, though, their worries are getting sick, losing parents or loved ones, and isolation. These are also my biggest stressors.
I have learned that in uncertainty, it’s good to maintain as much of your routine as possible. I wake up, drink coffee with my husband, shower, and get dressed for the day. Before work, I watch enough of the news to find out how many more people I need to include in my prayers.
As the primary caretaker for my 88-year-old mother, I head to her apartment on the 15th floor to check on her health and prepare her for the day. I’ve decided to take the stairs to make sure I get some exercise. My mom is recently out of the hospital for blood clots in her lungs, so her wellbeing is critical. Next, I walk five more flights to a friend’s empty apartment, which she has graciously offered to me for my work. I make a pot of tea and begin sessions for the day. My only outings (beyond walks) are weekly trips to the grocery store in a mask and gloves.
It is a lot easier now to talk about loneliness, which is a preexisting and concurring pandemic in our country. Most have difficulty admitting to loneliness—like it’s a personal defect—but it comes out naturally as a component of quarantine. I’m finding it is easier to bring up and talk about loneliness in the context of working from home and transition to how it is a familiar feeling to everyday life, pre-coronavirus.
Always in this work, I encourage my clients to build new practices that support getting out of anxious thoughts by engaging in behaviors that deliver good feelings and perhaps new ways of thinking about themselves and problems. For example, in support of overall well-being and connection, I recommend Kristin Neff self-compassion practices, Yoga with Adriene for strength, journaling ideas or gratitudes for the day, and anything creative, no matter the medium. I am also directing clients to check out Brené Brown’s new podcast Unlocking Us, the first episode of Brené on FFT (F**king First Times).
Sheltering in place offers decreased FOMO, removing the worry that others know more or are better at “doing the pandemic.” We are experiencing this first together yet physically apart. And we can learn through compassion and connection how to cope and build meaning. —Janet Ducharme
Graphics by Lorenza Centi.