Clinician's Quandary

My New Normal

How Our Work Has Changed Since Coronavirus

Psychotherapy Networker
My New Normal

The COVID-19 pandemic has radically shifted how almost every therapist works nowadays, in ways both expected and unexpected. Most clinicians have moved to doing teletherapy. Some have faced increased challenges as the situation ramps up anxiety and depression for already struggling clients. Many have put a creative twist on their usual interventions and, even in the isolation of quarantine, have found new ways of building rapport with clients as well as colleagues. Although we’re all in this together, no two stories are the same. Here, three therapists share what this new normal looks like for them.

1) “It Feels Like We’re Starting Over”

Most of my clients and I are now doing telehealth sessions. Overall, the process has been pretty smooth. But with couples, this sometimes gets a little awkward, since they’re forced to sit close to one another to get in the video frame and can’t really face each other without some extra effort. There are other challenges, too.

One of my clients, Tammi, has a long history of attachment and trauma issues. She’s highly vigilant and picks up on small signals easily. She’s also very sensitive to attachment interferences, so this has been a tough time for her.  After our most recent online session, she sent me an email:

I felt so disappointed after our last session. I think it’s because on video I don’t get the full range of gestures from you that I usually get in person—that’s probably 50 percent of our interaction. It’s hard for me to find the right words sometimes, so I rely on using gestures that I think are in sync with your responses. As you know, most of my life people never really said what they felt, so I had to rely on communicating this way.

I’m so grateful that we still get to have sessions, but I also think it’s going to take me some time to adjust to this. I know we can, I’m just not sure how right now. In some ways, it feels like we’re starting over, trying to sync together in this new way. Maybe we can take it slow, somehow, and process this more during our sessions.

It’s possible that other clients feel this way too, but don’t vocalize it like Tammi does. She’s more attuned, and determined to keep me informed. I’m going to take her up on the suggestion that we process what feels missing in these video sessions. It’s something that all of us may need to be more aware of, and perhaps process with certain clients.

David Wexler, PhD
San Diego, CA

2) A Longer Road to Presence

Jennifer, a 32-year-old professional golfer, told me during our first session, which was by video chat, that she loved her husband in every way, except that he lacked initiative in the bedroom. “He’s a great father and husband, and an engaging and a wonderful friend,” she said.

By the 45-minute mark, however, she leaned back and began to speak of him as dull, boring, and uneventful—not only in the bedroom, but everywhere. Rather than give the indication that she wanted to work it out, she instead spoke of a new life, one that involved new sexual partners; a life where she could explore her sexuality without her husband. There were clearly many stories I hadn’t yet heard from Jennifer, but this pivot threw me for a loop. I don’t think I hid my surprise very well.

I suspect part of my reaction can be attributed to working via video. In-person, I might’ve responded differently. But I’m finding that doing teletherapy drains a lot of energy from me. It takes more energy for me to communicate that I’m present and aware of nuances that are more obvious face to face. Right now, I’m working in a light-filled home office. It’s certainly not unwelcoming, but it’s different from the comfortable office where I usually see clients. It’s taking some getting used to.

I believe my greatest asset as a clinician is my presence, my ability to be present in the room with a client, to be able to listen and hold their struggles while helping them navigate their pain with hope and without judgment. It’s harder to articulate presence with teletherapy, at least for now. I’m exhausted at the end of the day. Honestly, I’m struggling, and I’ve only been doing teletherapy for a week now. I’m just starting this journey.

If this pandemic has taught me one thing so far, it’s the importance of taking a few minutes for myself between sessions. I’ll be doing that more going forward.

As for Jennifer, I’m glad that we’ll probably have the opportunity to work in-person once this is all over. I’m sure there are a lot of things about her that just can’t be communicated through teletherapy. Until we’re in the office together, I can’t know for sure.

Barbara Winter, PhD, CSAT, CMAT, FAACS
Boca Raton, FL

3) Helping My Clients “Grab a Toothbrush”

My main takeaway from being a therapist in the time of coronavirus is something I’ve long suspected is true but has been relatively untested in our field: When given empirically supported tools and then left to their own devices, human beings are more than capable of taking care of their mental health.

Since the pandemic, my clients have been forced to take on the challenge of embodying the skills we’ve learned together. They’ve been forced to sit with themselves, their relationships, and a national crisis. So far, they’re knocking it out of the park.

Oddly enough, I said something very fitting to a client right before coronavirus struck: “The assumed frame of psychotherapy—I’m going to heal you—limits your full potential to heal. This frame neglects half of your healing potential, the half that includes everything you bring to the table. Therapy is not a pill you pop. I’m only a guide, leading you into powers you already have.”

When I look around me, I see that our clients are among those most prepared to be with their uncomfortable thoughts and emotions. Whether they’re using exposure and response-prevention skills for OCD, doing daily mindfulness meditation, using DBT skills, setting healthy boundaries with loved ones, or exercising to help with depression, more than ever, the onus is on them to take care of their mental health with the tools they’ve been taught—and they’re stepping up to the plate.

Staying mentally healthy is like brushing your teeth: it’s a daily practice that everyone does—or should do, at least. As a society, we need to pay more attention to this. I believe that neglecting our mental health is the cause of greed that leads to oppression. It’s the source of racism, abuse, and shame.

This pandemic has only driven home what so many of us therapists already know: our society is a single organism, not made up of separate entities. Individualism is an illusion.

So what am I doing to help my clients? I’m encouraging them, more than ever, to aggressively help themselves. We as a therapist collective should be sending society the same message. As experts in well-being, we should be handing everyone a mental health toothbrush and toothpaste, so they can take time daily to clean their minds of the plaque that causes us, as a whole, to suffer.

Broderick Sawyer, PhD
Louisville, KY


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