My father Irvin Yalom used the term “fellow traveler” to describe an existential take on the therapist–client or doctor–patient relationship. Inherent in this is the idea that we are all in the same existential soup together, including the fact that we are all mortal beings, and struggle with the same fears and anxieties. Yes, we as therapists have certain skills to help our clients navigate the vicissitudes of life—but we ourselves are in no way immune to them! We struggle along with our clients, dealing with family traumas, relationship breakups, financial stress, and a quest for meaning.
The history of our profession, starting with Freud—a neurologist by training—in Victorian Vienna, has contributed to therapists being separated from our clients. This is true whether we consciously adapt the psychoanalytic blank slate model, or the various iterations which have filtered down into other approaches with codewords like “boundaries.” These constructs can be helpful—in moderation—but tend to separate us from our patients, and make us the “experts,” as if we are somehow above the fray.
One thing this pandemic makes clear is that therapists do not live in a privileged world. We are in the exact same situation as our clients: fearful for ourselves, our loved ones, and the world at large. We are worried about our health, and our financial security, and are rocked by the unchartered waters we are collectively sailing through. We don’t know what tomorrow or the next day will bring, and this uncertainty is extremely unsettling.
If indeed we are fellow travelers, then some will ask: “How can we help our clients if we are struggling with the same things they are?” This is a serious question, and a good one—but it assumes that we must somehow have overcome our issues or those inherent to the human condition in order to be of help. Somehow this hearkens back to this idea in psychoanalysis of the “fully analyzed patient” or other counterparts found in religious or self-help systems where someone achieves enlightenment, fully resolves their conflicts, or some other such silliness.
Yes, there are some folks who seem to have a good perspective on things, usually emanate kindness and ease, and generally seem to navigate life with equanimity. And there are others who seem to bathe in a state of perpetual psychological torment. But life is fluid, and no one is fully immune. Take a happily married, seemingly secure individual, have their spouse fall sick or die, have their economic security or physical security torn apart by a virus or a war or a revolution, and see how he or she fares. Most will not do so well.
But I digress. Getting back to the idea of fellow travelers...there is nothing like a pandemic to put us on equal footing with our clients! To even pretend otherwise, to not acknowledge to our clients that we are living on the same planet, that we are going through this epic crisis along with them, seems to me entirely disingenuous.
Simply put, we as therapists are not superhumans. The empirically validated truism that it is the relationship that heals still applies. And the relationship must be a genuine one, which I daresay isn’t possible with superhumans. We can’t and don’t want to be above the fray entirely—but when we are in our consulting rooms (or on our screens) with our clients, we must strive to be above the fray enough, for those 50 minutes or so, that we can put our worries aside and attend to our clients’ needs. We don’t even have to do this perfectly—we just have to do the best we can—to turn a phrase from Winnicot, we have to be a good enough therapist.
The basic principles apply: we are there to help our clients. Decisions about self-disclosure as always should be informed by what will best serve our clients. In general, it would seem that acknowledging that our lives are disrupted, that we are concerned, fearful or anxious about this pandemic is probably therapeutic, in the sense that it will normalize our clients’ experiences. For those that are quite isolated during this time, it adds to their sense of “we are all in this together.” Therapists often fear that self-disclosure may lead clients to wanting to inquire more and more about us, but that is rarely the case, as they are there to deal with their own anxieties. They just want to know that we are real. But should they want to shift the focus to ourselves, again we should keep the mindset of what is most helpful to them, and as always, attend to the process, not the content of their inquiries.
For example, you might say “I am appreciative that you are asking about how I’m doing; that shows the reservoir of empathy that you have, which is one of your great qualities. I’m getting by as best as I can, but it’s really frightening what is happening to the world.” And then see how they respond to what you say, and follow up with something like “How is it to be with me, and feel concerned about me? What reactions did you have to my response?” Or “I’m in a bit of a shock. I never imagined I’d live through something like this. And frankly, my work with clients like you is one thing that keeps me somewhat grounded; it helps me to know there’s something I can do to be of help.” And then again, wait, see how they respond to that, or ask them how your statement impacts them.
This is just one short example; this exchange would obviously vary widely among clients and therapists, depending on so many factors, including the therapeutic relationship, and the realities at the moment (Has the client lost her job? Does she know people who are sick, dead or dying from COVID-19?) And of course it’s not just one exchange; it might be a much longer conversation, or something the two of you return to as this crisis evolves.
We are fellow travelers. And we’ve chosen on this journey to be healers. Not witch doctors, not magicians, but psychotherapists, attending to our clients’ psyches. Clients may wish or even long for us to be the stabilizing force and voice of equanimity during these times of terror. And we certainly wish that for ourselves as well. Let it be an aspirational goal, but let us have self-compassion if we are all too human.
File under: The Art of Psychotherapy, COVID-19 Blogs
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The history of our profession, starting with Freud—a neurologist by training—in Victorian Vienna, has contributed to therapists being separated from our clients. This is true whether we consciously adapt the psychoanalytic blank slate model, or the various iterations which have filtered down into other approaches with codewords like “boundaries.” These constructs can be helpful—in moderation—but tend to separate us from our patients, and make us the “experts,” as if we are somehow above the fray.
One thing this pandemic makes clear is that therapists do not live in a privileged world. We are in the exact same situation as our clients: fearful for ourselves, our loved ones, and the world at large. We are worried about our health, and our financial security, and are rocked by the unchartered waters we are collectively sailing through. We don’t know what tomorrow or the next day will bring, and this uncertainty is extremely unsettling.
If indeed we are fellow travelers, then some will ask: “How can we help our clients if we are struggling with the same things they are?” This is a serious question, and a good one—but it assumes that we must somehow have overcome our issues or those inherent to the human condition in order to be of help. Somehow this hearkens back to this idea in psychoanalysis of the “fully analyzed patient” or other counterparts found in religious or self-help systems where someone achieves enlightenment, fully resolves their conflicts, or some other such silliness.
Yes, there are some folks who seem to have a good perspective on things, usually emanate kindness and ease, and generally seem to navigate life with equanimity. And there are others who seem to bathe in a state of perpetual psychological torment. But life is fluid, and no one is fully immune. Take a happily married, seemingly secure individual, have their spouse fall sick or die, have their economic security or physical security torn apart by a virus or a war or a revolution, and see how he or she fares. Most will not do so well.
But I digress. Getting back to the idea of fellow travelers...there is nothing like a pandemic to put us on equal footing with our clients! To even pretend otherwise, to not acknowledge to our clients that we are living on the same planet, that we are going through this epic crisis along with them, seems to me entirely disingenuous.
Simply put, we as therapists are not superhumans. The empirically validated truism that it is the relationship that heals still applies. And the relationship must be a genuine one, which I daresay isn’t possible with superhumans. We can’t and don’t want to be above the fray entirely—but when we are in our consulting rooms (or on our screens) with our clients, we must strive to be above the fray enough, for those 50 minutes or so, that we can put our worries aside and attend to our clients’ needs. We don’t even have to do this perfectly—we just have to do the best we can—to turn a phrase from Winnicot, we have to be a good enough therapist.
The basic principles apply: we are there to help our clients. Decisions about self-disclosure as always should be informed by what will best serve our clients. In general, it would seem that acknowledging that our lives are disrupted, that we are concerned, fearful or anxious about this pandemic is probably therapeutic, in the sense that it will normalize our clients’ experiences. For those that are quite isolated during this time, it adds to their sense of “we are all in this together.” Therapists often fear that self-disclosure may lead clients to wanting to inquire more and more about us, but that is rarely the case, as they are there to deal with their own anxieties. They just want to know that we are real. But should they want to shift the focus to ourselves, again we should keep the mindset of what is most helpful to them, and as always, attend to the process, not the content of their inquiries.
For example, you might say “I am appreciative that you are asking about how I’m doing; that shows the reservoir of empathy that you have, which is one of your great qualities. I’m getting by as best as I can, but it’s really frightening what is happening to the world.” And then see how they respond to what you say, and follow up with something like “How is it to be with me, and feel concerned about me? What reactions did you have to my response?” Or “I’m in a bit of a shock. I never imagined I’d live through something like this. And frankly, my work with clients like you is one thing that keeps me somewhat grounded; it helps me to know there’s something I can do to be of help.” And then again, wait, see how they respond to that, or ask them how your statement impacts them.
This is just one short example; this exchange would obviously vary widely among clients and therapists, depending on so many factors, including the therapeutic relationship, and the realities at the moment (Has the client lost her job? Does she know people who are sick, dead or dying from COVID-19?) And of course it’s not just one exchange; it might be a much longer conversation, or something the two of you return to as this crisis evolves.
We are fellow travelers. And we’ve chosen on this journey to be healers. Not witch doctors, not magicians, but psychotherapists, attending to our clients’ psyches. Clients may wish or even long for us to be the stabilizing force and voice of equanimity during these times of terror. And we certainly wish that for ourselves as well. Let it be an aspirational goal, but let us have self-compassion if we are all too human.
File under: The Art of Psychotherapy, COVID-19 Blogs