As I scrolled through the cartoons on our website, an image flashed through my mind. A therapist sits pensively across from their patient, framed by a newspaper caption on the wall behind which proclaims, “The pandemic is receding!” The therapist says to the patient, “OK, let’s talk about your new normal,” to which the patient laments, “But Doc, I didn’t even have an old normal.”
I am fully aware of the dangers and COVID-related challenges that linger, so am not proclaiming the pandemic’s recession, nor its end. However, I have directly experienced and am aware of the many ways in which the world is attempting to right and re-balance itself—from individuals to institutions to cities, states, and countries. People seem desperate to throw off the oppressive cloak of darkness and fear that the pandemic ushered in, as well as the emerging threats on all fronts, both medical and non. At the same time, people seem a bit less resistant to feeling their way down unfamiliar corridors, both public and private, even in the shadow of lingering uncertainties and elusive futures. We seem to be at an inflection point, or perhaps a liminality—a time of existential crisis on scales both small and large, not just for our patients and trainees, but also for ourselves as healers.
In a recent blog entitled Fellow Travelers During the Coronavirus Pandemic, Victor Yalom wrote, “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.” He couched this statement in the context of his father, Irvin Yalom’s notion that we, along with our patients, are fellow travelers. And as fellow travelers, I think that we have a two-fold obligation to find our way to a new normal, whether or not we or our patients had a firm grasp on an old one.
I like the idea that we and our patients are fellow travelers; however, the roads we travel may be very different from theirs, especially so for those who struggle day-to-day around the basics and don’t enjoy the privileges familiar to many of us and our professional colleagues. I have no doubt that COVID has been merciless for many of us and our colleagues, requiring adaptation and forcing upon us losses at many levels. But, as Roberta Satow said in The Uneven Effects of the Pandemic, “there is a great divide in this country in terms of race and class that has been exacerbated by the coronavirus…[and] as therapists, we must keep sight of the unevenness of the effects of the pandemic, empathizing with those who are suffering and encouraging those who are thriving (even ourselves) to not feel guilty.” So, as we return to a previous normal or attempt to construct a new one both for ourselves and our patients, I think it important to take this opportunity to explore deeply exactly what that means.
One of the more common return-to-normal phenomena that clinicians face is how to re-balance their therapeutic relationships between face-to-face and virtual interactions. From the perspective of the clinician, Matthew Martin’s The I-Thou Relationship in the Age of Telehealth- Part II suggests that “teletherapy holds the potential for new horizons for therapeutic gain. However, client and therapist must both be willing to cultivate the process of being together in authentic relation for these gains to find fruition.” Here, Martin addresses the seeming inevitability of telehealth as a newly-ubiquitous mode of psychotherapy delivery, and how, perhaps, it can evolve into a meaningful bridge for connection with our clients despite the geographic separation. This directly challenges the fear (or concern) therapists have historically and more recently voiced about telehealth’s inability to create real connection with clients or, as Lori Gottleib described it, of “doing therapy with a condom on.”
From the other side of the couch, Martin, in The Quarantine Void: A Reminder of the Central Role of Being, asks us to consider how COVID has forced many of his clients to reconsider the balance between “being” and “doing.” He says, “How my clients and I choose to respond to this new normal has the power to restore the centrality of being, along with our shared humanity, or bring us back into the dizzying energy of a doing-centered world.” Will we, as citizens both of the world and shepherds of our patients’ well-being, consider that balance alongside our clients as the shroud of COVID slowly lifts?
And what of our patients who entered the pandemic already struggling for balance in their lives, such as those whose lifelong relationship with introversion in a society that values its opposite left them feeling alone, different, alienated? While they may have struggled less than extroverts during the pandemic, many may have and are still struggling for the new balance that accompanies re-entry. In Pandemic Lessons for Introverts (and their Therapists), F. Diane Barth reflected on her clinical work with Melissa and shared, “the gradual ending of the isolation resulting from the pandemic has brought on some concerns, including what Melissa and several other clients call ‘fear of re-entry,’ that is, fears about returning situations in which interpersonal interactions stir up discomfort and anxiety.” How will we help those Melissas out there whose pre-pandemic normals were elusive?
Then there are clients whose pathologies and challenges were more unsettling and disruptive, not only for themselves, as they struggled for balance and normality, but for their intimates, who were often at a loss in the turbulent wake of their loved one’s personal battle. In a thought-provoking essay by Dana Harron, Eating Disorders, Couples, and COVID-19, we met Jamie, who had long struggled with Anorexia, and her partner Lyndon, who had become increasingly aware of Jamie’s disordered eating because of the forced isolation. With the aid of couples therapy, Lyndon became better “able to notice, and to share with Jamie, how out of control and alone he felt [and, with therapeutic support] became much better able to sit with his vulnerability [which] made him able to sit with Jamie’s vulnerability, too, and ask her about her feelings and experiences when he noticed her having difficulty with food.” In this case, it took a village to help Jamie and Lyndon wrestle a new normal from COPVID’s grip.
***
For some of us and our patients who have been fortunate, or perhaps privileged, enough to sidestep COVID’s unswerving trajectory, we have experienced an unavoidable and involuntary inflection point. Whether this inflection point was or has become an opportunity for growth, self-awareness and change certainly depends upon the way it has landed in our and their lives. Whether for better or worse, new normals await…hopefully!
File under: The Art of Psychotherapy, Musings and Reflections, Online Therapy, COVID-19 Blogs
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I am fully aware of the dangers and COVID-related challenges that linger, so am not proclaiming the pandemic’s recession, nor its end. However, I have directly experienced and am aware of the many ways in which the world is attempting to right and re-balance itself—from individuals to institutions to cities, states, and countries. People seem desperate to throw off the oppressive cloak of darkness and fear that the pandemic ushered in, as well as the emerging threats on all fronts, both medical and non. At the same time, people seem a bit less resistant to feeling their way down unfamiliar corridors, both public and private, even in the shadow of lingering uncertainties and elusive futures. We seem to be at an inflection point, or perhaps a liminality—a time of existential crisis on scales both small and large, not just for our patients and trainees, but also for ourselves as healers.
In a recent blog entitled Fellow Travelers During the Coronavirus Pandemic, Victor Yalom wrote, “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.” He couched this statement in the context of his father, Irvin Yalom’s notion that we, along with our patients, are fellow travelers. And as fellow travelers, I think that we have a two-fold obligation to find our way to a new normal, whether or not we or our patients had a firm grasp on an old one.
I like the idea that we and our patients are fellow travelers; however, the roads we travel may be very different from theirs, especially so for those who struggle day-to-day around the basics and don’t enjoy the privileges familiar to many of us and our professional colleagues. I have no doubt that COVID has been merciless for many of us and our colleagues, requiring adaptation and forcing upon us losses at many levels. But, as Roberta Satow said in The Uneven Effects of the Pandemic, “there is a great divide in this country in terms of race and class that has been exacerbated by the coronavirus…[and] as therapists, we must keep sight of the unevenness of the effects of the pandemic, empathizing with those who are suffering and encouraging those who are thriving (even ourselves) to not feel guilty.” So, as we return to a previous normal or attempt to construct a new one both for ourselves and our patients, I think it important to take this opportunity to explore deeply exactly what that means.
One of the more common return-to-normal phenomena that clinicians face is how to re-balance their therapeutic relationships between face-to-face and virtual interactions. From the perspective of the clinician, Matthew Martin’s The I-Thou Relationship in the Age of Telehealth- Part II suggests that “teletherapy holds the potential for new horizons for therapeutic gain. However, client and therapist must both be willing to cultivate the process of being together in authentic relation for these gains to find fruition.” Here, Martin addresses the seeming inevitability of telehealth as a newly-ubiquitous mode of psychotherapy delivery, and how, perhaps, it can evolve into a meaningful bridge for connection with our clients despite the geographic separation. This directly challenges the fear (or concern) therapists have historically and more recently voiced about telehealth’s inability to create real connection with clients or, as Lori Gottleib described it, of “doing therapy with a condom on.”
From the other side of the couch, Martin, in The Quarantine Void: A Reminder of the Central Role of Being, asks us to consider how COVID has forced many of his clients to reconsider the balance between “being” and “doing.” He says, “How my clients and I choose to respond to this new normal has the power to restore the centrality of being, along with our shared humanity, or bring us back into the dizzying energy of a doing-centered world.” Will we, as citizens both of the world and shepherds of our patients’ well-being, consider that balance alongside our clients as the shroud of COVID slowly lifts?
And what of our patients who entered the pandemic already struggling for balance in their lives, such as those whose lifelong relationship with introversion in a society that values its opposite left them feeling alone, different, alienated? While they may have struggled less than extroverts during the pandemic, many may have and are still struggling for the new balance that accompanies re-entry. In Pandemic Lessons for Introverts (and their Therapists), F. Diane Barth reflected on her clinical work with Melissa and shared, “the gradual ending of the isolation resulting from the pandemic has brought on some concerns, including what Melissa and several other clients call ‘fear of re-entry,’ that is, fears about returning situations in which interpersonal interactions stir up discomfort and anxiety.” How will we help those Melissas out there whose pre-pandemic normals were elusive?
Then there are clients whose pathologies and challenges were more unsettling and disruptive, not only for themselves, as they struggled for balance and normality, but for their intimates, who were often at a loss in the turbulent wake of their loved one’s personal battle. In a thought-provoking essay by Dana Harron, Eating Disorders, Couples, and COVID-19, we met Jamie, who had long struggled with Anorexia, and her partner Lyndon, who had become increasingly aware of Jamie’s disordered eating because of the forced isolation. With the aid of couples therapy, Lyndon became better “able to notice, and to share with Jamie, how out of control and alone he felt [and, with therapeutic support] became much better able to sit with his vulnerability [which] made him able to sit with Jamie’s vulnerability, too, and ask her about her feelings and experiences when he noticed her having difficulty with food.” In this case, it took a village to help Jamie and Lyndon wrestle a new normal from COPVID’s grip.
***
For some of us and our patients who have been fortunate, or perhaps privileged, enough to sidestep COVID’s unswerving trajectory, we have experienced an unavoidable and involuntary inflection point. Whether this inflection point was or has become an opportunity for growth, self-awareness and change certainly depends upon the way it has landed in our and their lives. Whether for better or worse, new normals await…hopefully!
File under: The Art of Psychotherapy, Musings and Reflections, Online Therapy, COVID-19 Blogs