Psychotherapy During a National Emergency

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Here’s a report from the front lines, where shrinks like me, devoted to maintaining or attaining the mental health of their clients, closed their offices, and opened their laptops or tapped their phones to stay in touch in a new world of social distance.

We’re now in a third phase of the corona virus pandemic. We don’t know how many phases there will be. That’s the first thing you learn in a pandemic, you don’t know what’s going to happen next. The first phase was before we learned that, when we thought the old rules applied, when we were surprised about what was happening. We were bemused to hear the news out of China, felt sorry for the passengers on cruise ships, and annoyed when basketball season was cancelled.

In phase I, even my most anxious clients believed the authorities were overreacting. They understood quarantine for affected individuals, but ironically thought it was unnecessary to cancel sporting events and restrict travel. I pointed out how brave they were and how differently they reacted to the global stress than their personal stressors. They’ve been canceling events, as well as quarantined and restricting themselves all their lives for less reason. They knew. They’ve always known their anxiety was unreasonable and could always recognize the anxiety of others.

Phase II began when all our lives became truly disrupted. It was more than something we saw in the news. We started to take it seriously. Phase II was a run on the grocery stores, including an inexplicably greedy binge on toilet paper. Phase II kicked in for me when I sensed fear. People were not going to want to see me in my office. I wrote a blog post and sent out an email saying a therapist’s office was the safest place to be, but we could stay in touch by phone if we needed. A day later, I closed the office and called everyone for their appointments.

It was then I remembered something I had noticed earlier in my career when I worked in a clinic with the very seriously mentally ill. During times of true community wide emergency, their symptoms all but vanished. Right after 9/11 and, here in Rochester, when we recovered from ice storms, even schizophrenia seemed to disappear.

This phenomenon is not as pronounced for me now because in private practice I seldom see folks with conditions as debilitating, but something similar happened in Phase II. Whatever concerned my clients before, did not concern them now. Moreover, we had a common concern. We’re in the same boat together, clinging to the gunwales, lost at sea, with sharks around us, and a storm beginning to brew.

In Phase II, we lost the plot, the narrative collapsed. We were glued to screens, craving the next update. We become data-driven when narratives fail. Our lives, instead of being literature, become arithmetic. We calculated the math of survival, the scarcity of staples, the losses in the stock market, the geometry of distancing, the probability of infection, the statistics of the curve, and the dwindling numbers of respirators.

Sitting in sessions with people in Phase II, it was hard to talk about what we had been talking about. Having those old concerns was like living under a rock. Because the narrative had proved unreliable, we were in survival mode. We needed to discuss the latest. I wanted to check in with them to see how they are faring, and they seemed to want to give a report. I felt bad because this conversation was little different from what they could get from anyone. Therapy is supposed to be something different. Yet, it was hard to go back to whatever we’d been doing before. That didn’t seem to matter now, for either of us; even though we know, as soon as the crisis passes, it will be right there for us again.

In Phase II, we looked for leaders. A leader would be anyone who seemed to have caught on to the new plot, who seized the narrative. Trump lost standing because he kept repeating the sentiments of Phase I, there was nothing to worry about. He seemed to have been living under a rock. Here in New York, Governor Cuomo gained standing because he seemed to have a grasp of an uncontrollable situation. Therefore, when he recommended businesses close on Tuesday, most of us complied. I did so out of respect for him.

My sense is, we are now entering Phase III. The old concerns are returning. People are settling into a new routine. The symptoms would be soon up to their old tricks again. There’s part of me that’s sorry to see Phase II go. Phase II proves the symptoms are unnecessary, the narratives are fiction, the routines repressive. I’m a therapist who’s always trying to shake things up when they’re settled and settle things when they’re shaken up. Now they’re settling. Do we have to settle so soon? Do we really have to return to our symptoms, pick up our drugs, and fight the same old fights we’ve been fighting with our loved ones?

For me, today I’m “seeing” clients by phone. I’ve signed up with a video provider, but they haven’t set me up, yet. They’re probably swamped. Tomorrow will bring something else. Maybe that etch-a-sketch pad that is our world will again be turned upside down. But adjusting to life is what life is all about. Maybe that’s what we all will learn: that we can adjust.

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