Holding and Mourning: A bit much for a week

Written on Sunday March 22, 2020

One hundred years and two months ago, Sigmund Freud lost his daughter Sophie to the Spanish Flu, the first pandemic of the 20th Century, four or five days after she fell ill. In a letter he sent to a colleague shortly after, Freud said that “it was a bit much for one week.” In our own different ways, this past week has been “a bit much” for myself, my patients, and most people I know.

While I have not lost a loved one, this past week I have felt fragmented and scattered, walking what sometimes felt like a tightrope between panic and denial. Like most of my fellow therapists, I have been scrambling to navigate uncharted territory, manage logistics to stay in business, deal with obscure and ambiguous information, and find answers in the context of overwhelming uncertainty for myself and for my patients.

This week has felt like a year, even counting for all the things I am grateful and privileged to have: a roof over my head, food in my pantry, health for myself and my loved ones, a partner to go through this with, friends to care for, reliable access to technology, and a dog on my lap as I start writing these lines. I also have, very importantly, a job that I can do remotely and will continue to give structure to my days and purpose to my life during these trying and scary times.

A week ago, I emailed each of my patients offering the possibility to start having our sessions remotely. I would have preferred to discuss this in person with them, to talk through their feelings about it and come to a mutual decision, but I realized we couldn’t wait. Some of them felt relieved and grateful for having the option, some seemed indifferent, and a few were doubtful and hesitant. I met the latter in person and saw the rest online.

Loss and fear are common currency in our trade, but few times they have felt as intensely present in the space -real and virtual- that my patients and I co-create. Over the last week, we sat together with the terror of the unknown, the fear of not seeing their loved ones again, the dreadful and lonely loss of human connection, the threats to their experience of safety, identity, and belonging, their guilt and powerlessness for not being able to help those in need, the overwhelming uncertainty about how to best protect and provide for their families, the anxiety emerging from the cracks in their sense of reality, and the anticipated loss of life as they knew it.

Holding my patients’ anxieties, in addition to my own, is always complex and can be a gigantic task. This is a part of my job as a therapist that I take very seriously, a part that I don’t think I will ever “get used to,” at least not in the sense of feeling it is easy. And it has been truly hard this past week. Most of my patients’ fears have resonated with me in somber ways, with my own fears, worries, and fantasies. While this is part of what allows me to understand them and I am grateful they share it with me, it has been a lot to carry for all of us.

One thing that has been new is not seeing my patients in person. I don’t routinely offer teletherapy. I believe there is no replacement for the experience of relating to and being with another human in person. So much of what happens and helps in therapy is unconscious, non-verbal, and body-based. I often use the immediacy of our shared experience, with its moments of tension and connection, to understand the reality of my patients and of the therapeutic encounter.

These days, however, the need to protect life trumps all other considerations, which is why starting tomorrow teletherapy won’t be optional. I feel it is important for me to recognize the loss embedded in that decision, a loss that I think deserves to be acknowledged and that I have already started to mourn with the people who chose to meet me over video from their home.

I missed those patients’ presence. I missed noticing the way they enter my office and sit on my couch. I missed their/our own idiosyncratic routines as we got reacquainted with the space. I missed being able to make eye contact with them, without the awkwardness of a camera that makes such a fundamental experience impossible. I missed how our silences filled the room with questions, sadness, anger, or peace. I missed noticing the tears that are now hidden in their pixelated faces, and how their hands and legs sometimes say something different than the words coming out of their mouths. I missed the way each of them made my office feel like a different space, and how that energy unfolded like a harmony with multiple textures, tones, and colors, the ongoing background for what they say, verbally or otherwise, and what they keep silent in our sessions.

There are many other aspects of my patients’ experience of teletherapy that I have been discussing with them. The intimacy of entering each other’s homes, the loss of a space that can be left behind when the session is over, the sense of safety that may come with a physically distant connection, and many others. As a therapist, I certainly need to attend to their experience and the meaning of this new normal in our relationship. However, I wanted to take a moment to write about my sadness and grief. Recognizing and mourning the loss of our shared physical space is a way to honor my patients, their presence, and the impact they have on me.

This week has been a bit much. I doubt that will change any time soon. Remaining open to all parts of myself, and helping my patients do the same, feels more important than ever. This means creating space to allow our grief, anxiety, and fear to be present in gentle ways, coexisting with resilience, agency, communion, gratitude, kindness, and hope. I want to remember not only that this too shall pass, as they say, but also that, in the meantime, we are all doing the best we can.

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Photo credit: Leticia Delboy