As a therapist, I’ve learned to read between the lines with my patients, recognizing that sometimes what isn’t said is just as important—if not more so—than what is said. Sometimes patients wait until the last five minutes of their session—or until they’re literally on their way out the door—to disclose what they really need to talk about. While I can usually sense when there’s more underneath the surface and attempt to explore, on some level it’s up to the patient to determine when she or he is going to be ready to begin the real work.
Right now, my encounters are restricted to a computer screen, and the view into my patients’ worlds is from the shoulders up. While that backdrop can provide an informative glimpse into a homelife I may have heard about but never seen, I miss the unconscious body language and context that in-office appointments afford. COVID and the subsequent telehealth reality have challenged me to pay even more attention to the words that are spoken (and those that are not), listening to patients more carefully and critically than ever before.
There’s a growing sense of urgency, desperation, but also respect. Patients are using every single minute of their 45- or 60-minute sessions. No one is late for an appointment any more, and very few run over, consciously aware someone else is counting on their time, too. There’s increased motivation and commitment to the therapeutic process, and I’ve been amazed and impressed by my patients’ improved abilities to be more transparent, raw, and truthful. While everyone reports concentration difficulties, I’m actually seeing the opposite in my sessions. There are countless distractions on both sides as we simultaneously juggle our respective work and family lives that no longer have distinction and balance. Everything is blurred together, but patients are continuing to show up for the real work, and actively asking for help sorting through it all.
Yes, therapy is very different for both the patient and the therapist, but great work is being done.
The stigma surrounding mental health treatment has also dramatically shifted over the last few months. The entire world is struggling with profound and prolonged stress, massive anxiety and uncertainty, depression, fear, staggering unemployment levels, and now, exploding and sickening racial injustices, growing destruction and resultant chaos on top of the continuing pandemic.
As a therapist, I was taught to use what patients bring into the room, or in this case, on screen. I now realize that we are struggling with many of the same concerns, including the hurt, the sorrow, and the absolute horror. There is a palpable leveling that has occurred. Although patient-provider relationships will always have a specific hierarchy and professionalism, what’s emerging is a deep humanity that we each recognize and appreciate, and around which we find a real therapeutic connection.
As a seasoned therapist of two decades, I exclusively saw patients in my private practice office until COVID. I was well-trained to be a blank slate for patients, focusing my complete attention on them. Now, I work from my kitchen table. While, at first, it felt strange to have patients see into my life and home, I remind myself, I’m not the only one working out of my kitchen. Many are speaking from their closets or bathrooms because they’re the only private places available. When asked, selective disclosures about myself and my own reactions to this time of profound uncertainty and unrest have normalized many of my patient’s realities making them feel less alone, and perceiving me as more authentic and more human.
Despite this new and positive layer of relating, I remain aware of the enormous responsibility I have when allowed into the sacred space of someone’s psyche. Patients are exposing greater and deeper vulnerabilities and are able to do so because of the times, and the trust we have established. That’s something I have to earn and then maintain. Patients no longer have the time to collect themselves after an emotionally charged session (e.g., when the content is acute grief, intense anger, trauma, marital conflict, etc.). Previously, they had time to regain composure on their way out of the office, to the elevator, the parking garage, and via their commute home. Now, patients get off the Zoom call and are immediately thrust back to their own lives and realities—sometimes with the person or situation that creates or triggers those fierce feelings and reactions. It’s now necessary to be meticulous in managing our time so I can gently pause a topic that will be resumed next week and wrap up our session satisfactorily. All of this occurs within a span of just minutes as we also say our goodbyes and I admit the next patient in from the Zoom waiting room. Clearly, there’s a lot going on here.
These virtual encounters are all we have for now, but with all their downsides, I still wouldn’t trade them for the world. I sincerely look forward to “seeing” all my patients and sharing their struggles, knowing they need someone to hear them, and to truly listen. Despite the initial learning curve, the technology frustrations, and the at-first, impersonal nature of our new connection, it has now become very familiar, even strangely comfortable. Yes, therapy is very different for both the patient and the therapist, but great work is being done. People are prioritizing their mental health more than ever, realizing the need and benefits of paying attention to how and what they are feeling—and actively doing something about it. My patients are showing up, doing the hard work, and challenging themselves to return to their lives, their relationships, and their communities as healthier, stronger, and more resilient people. And, they’re succeeding.