The call came at 5:45 in the morning from an unknown number in a familiar area code, an auspicious beginning to any day. An emergency room nurse was calling to inform me that my twenty-six-year-old son had been in an accident and had arrived at the hospital unconscious with a traumatic brain injury. He was nearly 2000 miles away and his prognosis was unclear.
I was due to see my first patient on Zoom in a little over an hour and had a full day scheduled. As panic set in, I literally started walking in circles and I knew that, “COVID be damned,” I was getting on a plane as soon as I could to be with him. I also knew that I could not take care of anyone else at that moment. I was channeling all of my energy to will him back to health.
For someone who is a planner, I have a professional will as well as a personal will, disability insurance, and life insurance. I was thoroughly unprepared to have my life upended so suddenly. I have maintained a solo psychotherapy practice for more than thirty years, and I’ve always managed my own schedule. There have been days when I woke up ill or had a sick child which required last-minute cancellations, but typically my absences were thought-out and scheduled. This was different. I quickly realized I was incapable of determining what next steps needed to be taken at that moment.
Operating on instinct and adrenaline, I called a close friend who offered to contact everyone on my schedule for that day. This was a godsend, because I knew I was unable to speak to anyone at that moment with any semblance of professional decorum. She also canceled the next day’s appointments, which gave me through the weekend to figure out what I would need going forward.
Just as I longed to have someone reassure me that my son would make a full recovery, I found myself wishing I had been better prepared for such an emergency. No one wants to have a dress rehearsal for trauma, but feeling so out of my depth only added to my distress.
Ironically, because of COVID-19, I had been working remotely for over a year and a half, which meant I had all my patients’ contact information on hand. In the past it would have been in my office and inaccessible to me from afar. Having up-to-date patient contact information readily available made it possible for me to draft an email to all my patients. Before writing to my patients, I called a colleague and asked her to cover my practice for me. In the email, I informed my patients that due to a family emergency I was taking a leave of absence from my practice for the month of July. I included contact information for my colleague in case they had an emergency. I promised to be back in touch by the end of the month with an update regarding when I might be able to resume work. In the email I tried to walk the line between providing sufficient but limited information about my son’s accident. Since I didn’t trust my ability to communicate clearly, I asked my colleague to proofread my email and kept her in the loop of what information my patients had.
Traumatic events rip the Band-Aid off our belief that we are in control of our lives. Without this protective layer it can be hard to regulate emotions. At other times when there was stress in my personal life, work often offered a respite from these concerns. But this time was different. Living out of a hurriedly-packed suitcase in an unfamiliar city and spending long hours at the hospital each day was exhausting. Although my son’s prognosis improved, the timeline for traumatic brain injuries is not clear cut. In the early days of my son’s hospital stay, I was consumed with fear and anxiety for his well-being and future. Both my husband (who went on FMLA for the month of July) and I were riding the waves of our son’s recovery and setbacks, unsure of when we could return home and resume our life.
Having been immersed in a pandemic for over a year was a good lesson that plans need to be held delicately and that caveats are the rule, not the exception. As we spoke with the medical personnel about discharge plans for my son and the possibility of his returning home with us, I began to do a self-assessment about my capacity to work.
Therapists are not interchangeable, and the particulars of each case are privy only to those in the relationship. This puts additional pressure on clinicians to return to work. When I am on vacation, thoughts of various patients enter my mind. Often, I have found those periods to bring fresh insights into my work. But this was far from a vacation, and I had no bandwidth to think about my patients. This was one measure I used to assess whether or not I thought I was ready to work. The first time I found myself on a walk with thoughts of a patient entering my awareness, I took that as a sign of my own road to recovery.
Fortunately, my son improved more quickly than anyone predicted, and we were able to bring him home with us. Despite his favorable outcome, the remnants of this traumatic event left me emotionally raw.
As promised in my first email, I sent another email to all my patients at the end of July. I updated them about my son’s progress and my decision to return to work at the beginning of August. As a way to check in and allow each of them to ask questions without using their clinical hour, I decided that I would call each of them before scheduling a session. I wasn’t able to talk easily about my son’s condition, and I was afraid of getting overwhelmed with my own emotions during their clinical hour. I scheduled four phone calls a day with time in between each one. After a month, or more in some cases, since our last appointment, I didn’t think it was fair to use their time with me to update them on my situation.
As with any significant interruption in a therapy relationship, each patient handled the break differently. One patient said, “I know in the back of my mind that you’re a mother, but I never think about you that way. I was so worried for you because I know I couldn’t bear to lose one of my kids.” Other patients were afraid I might never come back to work and felt selfish for having this concern. A few patients decided not to resume sessions, reporting that the month away had given them an opportunity to decide that they were doing well. I wasn’t surprised by this reaction and tried to process it with each one to bring closure. Two patients gave birth during the month I was away, and both spoke about how differently they reacted to my situation because of their new role as a mother. All of my patients expressed concern for me and appreciation for our connection. I found this especially meaningful at a time when I was questioning so much about the vagaries of life.
Initially there were some bumps in the road as I returned to work. Some patients struggled to share their concerns without feeling self-conscious. They compared their situations to mine and felt foolish to be upset over seemingly trivial matters. This is a common concern in therapy and one I have encountered many times over the years. As I struggled with managing my own anxiety, I was afraid I wasn’t projecting my usual self-assured presence to my patients. A few colleagues of mine have had to navigate more difficult life events, such as sudden deaths and personal medical crises while continuing to work, so I reached out to some of them for support and guidance.
To take care of myself, I started back to work slowly, spacing out sessions when possible. Not surprisingly I was exhausted at the end of each day, yet I found sleep hard to come by. Three weeks after returning to work, I took a previously planned vacation. This further disruption to my practice was admittedly quite difficult for some of my patients, but it felt crucial for my own well-being. During my two weeks off, I noted all the ways a vacation felt so different from an emergency leave, and I returned to work in September more refreshed. This additional break had an unexpected outcome in that it allowed my patients to express a wider range of feelings about my absence. As one patient said, tongue in cheek, “You won’t be doing that again for a long time!” She was in the middle of a painful divorce, and the timing of my absences was especially hard for her. She could express her feelings after my vacation, but not when I returned from my leave.
Modeling self-care is different from talking about it. As therapists, we know “actions speak louder than words,” but often we communicate “do as I say, not as I do.” I thought back to all the times I’ve encouraged patients to take a leave from work or make other life changes to support their own mental health. I could sense how carefully some of my patients were watching to see if I was truly okay. For those who are invested in keeping me on a pedestal, the illusion of my perfect life was shattered, and this was an uncomfortable intrusion into the transference. For others, knowing that something bad had happened to me helped them trust that I could actually understand their pain. Still others expressed an increase in their fear that if I wasn’t safe from harm, then no one could protect them. Processing this variety of responses while tending to my own anxiety was challenging.
***
Throughout my career, there have been stories from my life that I occasionally share with patients as points of illustration or connection. One day I hope I will be able to draw from this recent traumatic experience in a similar way, but for now it is still too raw. As we near the sixth month mark from the accident, the timeframe given by the medical professionals for the fractures to fully heal, all indications are that my son will make a full recovery. I am truly grateful for this outcome, but tears are still close to the surface for me. It takes time to integrate such a life-changing experience, but with support from others I trust I, too, will heal.
Being a psychologist is one of my life’s greatest pleasures. It gives me a sense of purpose and allows me to engage fully with other people. Relying on myself for so many years in private practice comes naturally to me, but this recent experience was my wake-up call that I need to be better prepared to make sure my patients can be cared for in the event that I can’t do it by myself.
File under: The Art of Psychotherapy, Musings and Reflections, COVID-19 Blogs
I was due to see my first patient on Zoom in a little over an hour and had a full day scheduled. As panic set in, I literally started walking in circles and I knew that, “COVID be damned,” I was getting on a plane as soon as I could to be with him. I also knew that I could not take care of anyone else at that moment. I was channeling all of my energy to will him back to health.
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For someone who is a planner, I have a professional will as well as a personal will, disability insurance, and life insurance. I was thoroughly unprepared to have my life upended so suddenly. I have maintained a solo psychotherapy practice for more than thirty years, and I’ve always managed my own schedule. There have been days when I woke up ill or had a sick child which required last-minute cancellations, but typically my absences were thought-out and scheduled. This was different. I quickly realized I was incapable of determining what next steps needed to be taken at that moment.
Operating on instinct and adrenaline, I called a close friend who offered to contact everyone on my schedule for that day. This was a godsend, because I knew I was unable to speak to anyone at that moment with any semblance of professional decorum. She also canceled the next day’s appointments, which gave me through the weekend to figure out what I would need going forward.
Just as I longed to have someone reassure me that my son would make a full recovery, I found myself wishing I had been better prepared for such an emergency. No one wants to have a dress rehearsal for trauma, but feeling so out of my depth only added to my distress.
Ironically, because of COVID-19, I had been working remotely for over a year and a half, which meant I had all my patients’ contact information on hand. In the past it would have been in my office and inaccessible to me from afar. Having up-to-date patient contact information readily available made it possible for me to draft an email to all my patients. Before writing to my patients, I called a colleague and asked her to cover my practice for me. In the email, I informed my patients that due to a family emergency I was taking a leave of absence from my practice for the month of July. I included contact information for my colleague in case they had an emergency. I promised to be back in touch by the end of the month with an update regarding when I might be able to resume work. In the email I tried to walk the line between providing sufficient but limited information about my son’s accident. Since I didn’t trust my ability to communicate clearly, I asked my colleague to proofread my email and kept her in the loop of what information my patients had.
Traumatic events rip the Band-Aid off our belief that we are in control of our lives. Without this protective layer it can be hard to regulate emotions. At other times when there was stress in my personal life, work often offered a respite from these concerns. But this time was different. Living out of a hurriedly-packed suitcase in an unfamiliar city and spending long hours at the hospital each day was exhausting. Although my son’s prognosis improved, the timeline for traumatic brain injuries is not clear cut. In the early days of my son’s hospital stay, I was consumed with fear and anxiety for his well-being and future. Both my husband (who went on FMLA for the month of July) and I were riding the waves of our son’s recovery and setbacks, unsure of when we could return home and resume our life.
Having been immersed in a pandemic for over a year was a good lesson that plans need to be held delicately and that caveats are the rule, not the exception. As we spoke with the medical personnel about discharge plans for my son and the possibility of his returning home with us, I began to do a self-assessment about my capacity to work.
Therapists are not interchangeable, and the particulars of each case are privy only to those in the relationship. This puts additional pressure on clinicians to return to work. When I am on vacation, thoughts of various patients enter my mind. Often, I have found those periods to bring fresh insights into my work. But this was far from a vacation, and I had no bandwidth to think about my patients. This was one measure I used to assess whether or not I thought I was ready to work. The first time I found myself on a walk with thoughts of a patient entering my awareness, I took that as a sign of my own road to recovery.
Fortunately, my son improved more quickly than anyone predicted, and we were able to bring him home with us. Despite his favorable outcome, the remnants of this traumatic event left me emotionally raw.
As promised in my first email, I sent another email to all my patients at the end of July. I updated them about my son’s progress and my decision to return to work at the beginning of August. As a way to check in and allow each of them to ask questions without using their clinical hour, I decided that I would call each of them before scheduling a session. I wasn’t able to talk easily about my son’s condition, and I was afraid of getting overwhelmed with my own emotions during their clinical hour. I scheduled four phone calls a day with time in between each one. After a month, or more in some cases, since our last appointment, I didn’t think it was fair to use their time with me to update them on my situation.
As with any significant interruption in a therapy relationship, each patient handled the break differently. One patient said, “I know in the back of my mind that you’re a mother, but I never think about you that way. I was so worried for you because I know I couldn’t bear to lose one of my kids.” Other patients were afraid I might never come back to work and felt selfish for having this concern. A few patients decided not to resume sessions, reporting that the month away had given them an opportunity to decide that they were doing well. I wasn’t surprised by this reaction and tried to process it with each one to bring closure. Two patients gave birth during the month I was away, and both spoke about how differently they reacted to my situation because of their new role as a mother. All of my patients expressed concern for me and appreciation for our connection. I found this especially meaningful at a time when I was questioning so much about the vagaries of life.
Initially there were some bumps in the road as I returned to work. Some patients struggled to share their concerns without feeling self-conscious. They compared their situations to mine and felt foolish to be upset over seemingly trivial matters. This is a common concern in therapy and one I have encountered many times over the years. As I struggled with managing my own anxiety, I was afraid I wasn’t projecting my usual self-assured presence to my patients. A few colleagues of mine have had to navigate more difficult life events, such as sudden deaths and personal medical crises while continuing to work, so I reached out to some of them for support and guidance.
To take care of myself, I started back to work slowly, spacing out sessions when possible. Not surprisingly I was exhausted at the end of each day, yet I found sleep hard to come by. Three weeks after returning to work, I took a previously planned vacation. This further disruption to my practice was admittedly quite difficult for some of my patients, but it felt crucial for my own well-being. During my two weeks off, I noted all the ways a vacation felt so different from an emergency leave, and I returned to work in September more refreshed. This additional break had an unexpected outcome in that it allowed my patients to express a wider range of feelings about my absence. As one patient said, tongue in cheek, “You won’t be doing that again for a long time!” She was in the middle of a painful divorce, and the timing of my absences was especially hard for her. She could express her feelings after my vacation, but not when I returned from my leave.
Modeling self-care is different from talking about it. As therapists, we know “actions speak louder than words,” but often we communicate “do as I say, not as I do.” I thought back to all the times I’ve encouraged patients to take a leave from work or make other life changes to support their own mental health. I could sense how carefully some of my patients were watching to see if I was truly okay. For those who are invested in keeping me on a pedestal, the illusion of my perfect life was shattered, and this was an uncomfortable intrusion into the transference. For others, knowing that something bad had happened to me helped them trust that I could actually understand their pain. Still others expressed an increase in their fear that if I wasn’t safe from harm, then no one could protect them. Processing this variety of responses while tending to my own anxiety was challenging.
***
Throughout my career, there have been stories from my life that I occasionally share with patients as points of illustration or connection. One day I hope I will be able to draw from this recent traumatic experience in a similar way, but for now it is still too raw. As we near the sixth month mark from the accident, the timeframe given by the medical professionals for the fractures to fully heal, all indications are that my son will make a full recovery. I am truly grateful for this outcome, but tears are still close to the surface for me. It takes time to integrate such a life-changing experience, but with support from others I trust I, too, will heal.
Being a psychologist is one of my life’s greatest pleasures. It gives me a sense of purpose and allows me to engage fully with other people. Relying on myself for so many years in private practice comes naturally to me, but this recent experience was my wake-up call that I need to be better prepared to make sure my patients can be cared for in the event that I can’t do it by myself.
File under: The Art of Psychotherapy, Musings and Reflections, COVID-19 Blogs