Annals of a therapist during COVID-19: Day 1

3/26/2020

I’d intended, since I went into social isolation about twelve days ago, to write a few blog posts. Funny, uplifting stories and perspectives was the goal, because I think now more than ever, we need the ability to find joy and laughter.

And I might still do that. All bets are off.

But I haven’t yet been able to access that part of me that can pop off a funny anecdote like it’s nothing. The inside of my head is usually a ticker tape parade, colorful and chaotic and overwhelming, and often joyous. Now, though, it’s more like a funeral procession. My brain mechanics feel rusty and worn, slow and heavy, like maybe one of the gears fell out altogether and the others are having to compensate, but aren’t quite up to snuff. Like maybe the whole machine is about to go kaput.

The era of COVID-19 isn’t easy for anyone, so I’m not trying to say my mental distress is special. It’s not. I’m floundering in a completely foreign situation just like everyone around me is. Problem is, I’ve got people looking to me for help, too. I’m still a therapist, even if the world is upside down and inside out. Especially because the world is upside down and inside out.

It’s been a weird road, these past two weeks. The week leading up to Friday the 13^th of March, I was still in a state of heavy denial. The virus was just another flu. I was going to Jamaica on March 21, as planned for over a year. Over that week, I started the process of acknowledging and grieving what my losses were shaping up to be. And on Saturday the 14^th, I woke up and was like “waiiiit holy shit, hold the phone, what are you doing?” It was a strange experience, like all of these new and very real thoughts had infiltrated me and I couldn’t understand why they hadn’t been there all along. I accepted the reality and gravity of Coronavirus in a new way, and grasped my responsibility in flattening the curve. I cancelled my vacation. I got a telehealth platform set up for my practice. I emailed every client to tell them there would be changes in my service delivery. I created consent documentation and consulted consulted consulted. Between Saturday and Monday, I transformed my practice completely. It was exhausting, but exhilarating. I love learning, and I had to—and fast.

Fueled by caffeine, novelty, and optimism, I marched into last week. I saw twenty clients over telehealth, and the process went beautifully. No tech issues, and the whole videoconferencing thing felt a lot less interpersonally weird than I thought it might be. It felt empowering to be able to offer hope and guidance in bleak times. I ended the week with a sense of relief that I could still be a steady presence for my clients, put some good into the world, and also bring in some income for my family.

Enter this week. Now, I was supposed to be on vacation this week, so I opted to keep my caseload light. I scheduled nine people. I had hoped for a restorative week, filled with mostly reading and junk TV and personal stay-at-home projects. It has turned out to be a week of battling with insurance companies, intense client stress, and coming to grips with the mortality of my world. It has turned out to be a week of increasingly horrifying news, a week where I had conflict with family and friends about what “social distance” means in terms of how to enact it successfully, a week of fear and frustration and almost constant anger and anxiety. I’m trudging into Friday feeling like I’ve been steamrolled.

Today I held the sadness of a senior who will likely not celebrate the end of her high school career elbow-to-elbow with her friends. I held the desperation of a refugee who is running out of food with no apparent means of getting more, and whose children have fallen ill, possibly with Coronavirus. I held the anxiety of a pregnant mother who is unsure her partner will get to be in the delivery room with her when she labors. I witnessed the fear of my colleagues as we wonder if and how we will be reimbursed fairly for the important services we provide to others, in the age of telehealth, and I went to bat with and for them in the ways that I could.

Today I had my first panic attack in years.

Because the trauma of my clients is different than mine, but the same. I hold for them the very things I fear myself. Scarcity, financial ruin, loss, and death.

I assume tomorrow, if operating on a better night’s sleep, I will wake with a sunnier disposition. Optimism is my default, to the extent to which clients have described sessions with me as “hope infusions.”

But euthymic mood notwithstanding, I have no delusions of the next few weeks being easy. On me, on anyone. I think we’re in for some real shit, people.

And I guess until my funny bone kicks back in, I’m going to document it.

Half my life

I recently turned 35. I’ve been with my husband, Jeb, for 17.5 years. Do the math: I’ve been with this man half my life.

Yet not even the knowledge that comes with time can stop me from sometimes being plagued with doubt. I often worry whether we’re doing marriage “the right way.” I don’t know about you, but I do this thing where I look at other couples and assume they have it all figured out, everything in their life is perfect and wonderful. I go so far as to let others’ lives play out like movies in my mind. Other couples, watching every TV show together, spending all night talking. Agreeing on every single opinion about every single thing in life, ever. Skipping through dewy meadows in their perfectly pressed clothes and clean shoes, then going home to their pristine houses. (Y’all are killing it, in my imagination.)

I wonder if people do that with me and Jeb. We have an exceptionally well-documented life via social media, due to Jeb being a photographer and also knowing a lot of photographers. A quick perusal of either of our Facebook  accounts reveals lots of pretty pics of us, all made up. Tons of snaps of our kids being awesome. Photos from tropical vacations, and warm, cozy holidays. Our social media screams “We’re happy! SO FREAKING HAPPY!”

And that’s about half of the truth. A lot of the time, we are happy, content, doing fine.  

And a lot of the time, we’ve struggled.

Getting married is easy. You find someone you love. You think, yeah, I could spend my life with this person. You have a celebration and your friends and family all show up and everyone cries. The world is your oyster; everything is possible.

It’s staying married that’s hard.

If you’d have asked me at twenty-three, which is how old I was when I got married, I’d have predicted that over the years, I’d change very little—I knew who I was, what I wanted, the road I was headed down. I had it all figured out.

Except I didn’t and I didn’t have enough foresight to see that I didn’t.

People can change a hell of a lot over time, and I think it’s possible that Jeb and I changed more than most. I pursued many years of higher education, and due to that, was exposed to ideas and people and adversity and growth and culture in a way that molded me, shaped me, carved me into a different person. As for Jeb, he left his job as a public school educator and became a full-time photographer/creative. He learned that he needs to be making things, thinking outside of the box, and not answering to a hierarchy to feel fulfilled through his work.

We also became parents of two kiddos in a span of twenty months, so as we were stretching and learning and developing our singular identities, we were also immersed in the task of keeping tiny humans alive.

The years marched on. I got my PhD and started a private practice. The kids started school. We went to family celebrations. We hung out with friends. We did date nights sometimes. We traveled. We pursued individual hobbies and interests. We built a house and moved to a lovely new neighborhood.

And then one day in our thirties we woke up and realized we had no idea who the other was. I won’t speak for his side of it, but my personal awakening came with the question: Why are we together? We had different groups of friends. We didn’t read the same books, or necessarily gravitate to the same kinds of media, or have any hobbies in common. I loved Jeb, but I didn’t know why I was with him anymore.

At about the same time I was grappling with these serious questions about my marriage, I became depressed— so depressed I couldn’t even see straight. It seemed like every decision I’d ever made in my life was wrong. I questioned my entire existence as a human being: where I’d come from, what I was doing now, where I was going. It was hell. And Jeb got angry and withdrew. He didn’t know what to do with me; didn’t understand what I was trying to say when I talked about my questions, about my doubts, about what wasn’t working for me in our marriage. In hindsight, he was depressed, too, but men sometimes look different when they’re depressed. (Google Masked Male depression for more on that.)

And we fought. Good Lord, did we fight. There were tears and storming out and many nights spent sleeping apart. I spent the night of our 11^th wedding anniversary at my parent’s house, that’s how bad it was.

We contemplated separation. We ate meals together with our kids and had our best “everything is fine” faces on, even as I researched apartments, always late at night, or at the office, while I wept my way through my fifth box of Kleenex.  

But in the chaos, something miraculous happened. We fought for each other. Even through all the squabbling and miscommunicating and passive-aggression, we kept coming back to the same point: we wanted to try. We wanted our family. We wanted to see if we could find each other again.

So we tried. We went to therapy together, and went to therapy individually. First, we bent. I started trying harder to listen to him when he was sharing something he was excited about, even when I was exhausted from listening to people all day, and even if what he was saying didn’t interest me. He started greeting me when I came in the door after work, and went out of his way to tell me all the ways he appreciates me. Essentially, we slowly figured out the ways we had been failing each other and made the others’ emotional needs a priority again. We made a few big shifts, but mostly, we made a million little changes.

And after awhile, we had bent so much that we softened; the rigid edges of us melting. I let him back into the places in my spirit that had long been steeled against him. Though he isn’t and will never again be the man I married, he became a man I wanted to stay married to.

I don’t think that Jeb’s my soulmate. This is because I don’t believe in soulmates, this idea that you can meet someone and POOF, love happens and it’s forever and you don’t have to do anything to make it work. I used to buy into this stuff, and sometimes that wily belief wants to come weaseling back in—mostly when Jeb and I are struggling. I think, during those rough times: “Oh, if only I’d found my soulmate and married him, then I wouldn’t be going through any of this arguing or pain or doubt.” But you know what? I call bullshit. What I really believe in is two people fighting for each other and choosing each other again and again and again, every day. I can’t think of any better definition of love than that.

I didn’t write this for some kind of “atta girl.” I’m not aiming for you all to see me as a paragon of morality, because believe you me, the level of fuck uppery that I’ve reached during these years of growth and struggle has been unreal. I also fully anticipate that I will in some way, at some point, mess something up again.  Our struggle isn't over. It's not a thing that ends. I think marriage/partnership is less like a straight line with some kind of destination that a couple can arrive at, and more like a circle with little pit stops along the path, some happy, some sad, some totally fucked up. And round and round the circle you go, hopefully learning how to navigate the rough times as you know yourself and your partner better.

I also didn’t write this to shame those of you who have divorced or ended long term partnerships. I don’t think every relationship can be saved, or should be.  

I wrote this for the folks like me, who are sitting there comparing their imperfect relationship to everyone else’s “perfect” one, lurking and hiding in secret shame. If your marriage is messy, if there’s some stain on it that you wish wasn’t there but is, if you’ve hurt your partner or been hurt, if you’ve wondered if you made the “right” choice in a partner—you’re not alone. You’re more normal than you think. The more I talk to people who I’m real with, and who are real with me, the more I realize that every long term romantic relationship has problems. It’s what we do with the problem that matters.

As for me, I’m going to keep trying with Jeb for as long as it makes sense to try. Being with him for half of my life hasn’t been nearly long enough.  

Photo: Sarah Gudeman   http://www.sarahgudeman.com

Breaking the rules

I broke one of my own rules for being a therapist today.

I cried.

You wouldn’t know it from watching how “therapy” is done on TV, but therapists have a lot of rules to follow. Some of them are set for us by ethical codes of our profession—things like “keep client information private and protected” (duh) and “don’t have sex with clients” (double duh).

And then, most therapists have these other rules that we place upon ourselves, things that have less to do with the general ethical codes and more to do with our own personalities, preferences, and theories of how we help people.

“No crying” isn’t a hard and fast rule for therapists. In fact, it’s subject to some debate within our field. I poignantly remember getting close to tears once with one of my very first clients. Because I was still in training at the time, I brought it up with my peers and supervisors. Through discussion, I came to more fully appreciate a powerful truth: that therapy is not a one-size-fits-all endeavor. I learned that probably each of us would handle this in our own way, and that this was okay, because we each have our own unique personalities and ways of helping people. And that day I set my own personal standard on crying in session.

But today, I deviated from my personal standard and cried. I will usually let myself get to “misty eyes,” and that’s my cutoff. That’s where I internally say to myself “Alright, this isn’t about you” and tuck in the tears. Today I couldn’t. My eyes filled up and a couple of tears spilled over. I wasn’t sobbing or totally losing my shit in any way. Yet it was definitely crying, and I know my client saw.

I like to think that I chose that no-crying standard for benevolent reasons—to benefit and protect the client. I want to prevent therapeutic interactions from becoming “the Allison show”—that is, the heart of therapy should be the client’s experiences, not mine. In order to really be effective, I need for clients to know and believe that I’m hanging in there with them, no matter what they’re talking about and what pain they are expressing. I fear that if they see me cry, they might start to think they are hurting me and start holding back on me. This is the last thing that I want, as people are often already holding back a lot in their lives outside of therapy, in order to protect themselves and others.

Yet, as with so many things in life, there is another way to look at this. And this other perspective could make me out to be a hypocrite (again, damnit!).  In my point of view, crying is simply an expression of sadness. I also believe that letting others see our emotions is a genuine and hence courageous thing to do -- showing others who we are and what moves us is one thing that helps us others feel connected to us. (I say these things to people all the time! All. The. Time.) So, in showing clients that I’m moved by what they have said, am I possibly modeling an appropriate expression of emotion and maybe even aiding our connection?

*big gulp, tiny voice* And, is it also possible that the real reason that I don't let myself cry in front of clients is because I dislike others, client or not, seeing my vulnerability? (Damnit.)

IDK, being a therapist and making therapisty decisions is hard.

What I do know is that my emotional control in therapy has been tested lately. I've heard some of the saddest stories that I've ever heard; often situations that are very personally relatable. And while I do work hard to keep my own personal baggage out of the therapeutic interaction, at the end of the day I'm still human. The things that people say, that I witness through listening to client's stories with my heart and playing those stories through in my mind-- they affect me. Some stories are told with such immediacy and detail that the hardest thing in the world would be to not see it through my client's eyes. Sometimes the pain in the room is so palpable that it steals my breath, like I’ve been socked in the gut.

To be both naturally imaginative and empathic is a blessing-- these attributes make me who I am, and they are the backbone of my work as a therapist. Yet these very same attributes are the ones that keep me up at night and that allow me to imagine terrible things happening to me and those that I love-- and they're the personal characteristics that are making me cry in session! Stupid paradoxes everywhere!

Anyway, yes, the tears have been happening and I think they’re likely to keep on happening. Sometimes they will behave themselves and stay in my eyes, and other times they may go rogue on me and escape. As you can probably tell from the rest of this post, I’m still not 100% sure how I feel about this level of personal sadness being out in the open for clients to see. I'm well aware that there is processing that I can and will do with clients if I cry, and that this can give me a sense of where to go from there. I'm just still not sure I should be letting it happen in the first place.

Instead of the nice tidy resolution that I seem to go for in these posts, today I’m going to have to leave stuff hanging. I’m still working on figuring this whole thing out. Maybe I’ll stick with my old no-crying rule. Maybe I’ll come up with a new rule. I'm just going to roll with the ambiguity of it all today, and find solace in knowing that I’m working on understanding.  Life’s messy, folks.

And in the spirit of dialogue and progress, I’d like to end this post with a question: If you were (or are) a client in therapy, what would it be like for you if your therapist was so moved by something you said that s/he cried?

Following My Own Damn Advice

So there’s this thing that happens sometimes when you’re a therapist. I call it, “When you don’t follow your own damn advice.” Let me paint the picture:

A client is having a difficult time relaxing because they have “too much to do.” And let me be clear, in this scenario I’m not talking about the single mom so strapped for cash that she is working three jobs while also childrearing—that’s a bit different.  The clients I’m talking about are the college students who are double-majoring and working in a lab and participating in a bajillion clubs, and the parents who have their kids signed up for every possible out-of-school activity while also working, maintaining a home, and participating in community organizations, etc. When I ask these sorts of clients why they’re doing the things that they’re doing, the most common response is that scrunchy, lip-curly facial expression that implies that they think I might be dim, and the old standard: “Because I have to.”

The thing is, though, that that they don’t have to. There are really only a few things that we absolutely have to do—you know, the things that we do to avoid foreclosure on our homes, or failing or course, or certain death. And truly, even those things are choices. Think about it. I could blow off my clients and not show up at work, any given day. Instead, I could laze about on the couch in my PJs while watching Parks & Rec on Netflix and eating entire cheesecakes while intermittently, peacefully dozing (which may or may not be a recurring fantasy of mine). But I choose not to do those things— to avoid negative consequences, not because I have to.

Which leads me to my next client intervention, which is when I say something like, “How congruent are your life choices with your values?” This can lead into a really cool phase of therapy, when people are actively thinking about their values (sometimes for the first time), and then, when the therapy stars align with Jupiter or Mars or some shit, making changes so that their lives are made of things that they choose, rather than lives built around guilt, avoidance of pain/hurt, or martyrdom. Eureka! It’s amazing stuff, when it works.

On the heels of intervening in this way with a client, I self-reflect. And ooooh boy, does that self-reflection get me every time.   Not only do I have a mini-crisis of conscience (i.e., “What the hell are you doing with your life, Allison?”), but I get the added bonus of getting to feel like a huge hypocrite—that is, the whole “you can’t follow your own damn advice” phenomenon. I can’t even do the thing that I’m asking clients to do. In sum, this is a sucky experience. And it happens to me all the time.

Now, doubtless some of you readers are getting all high and mighty right about now. You’re looking at your screen dubiously, disdainfully. Your chests are all puffed out, your chins are held high.  You might be flexing your biceps in the mirror a little bit, just to remind yourself of your physical prowess. (I have no idea where I’m getting this stuff. Just go with it.)  Your thoughts are along the lines of:  “Well, I’VE got it all together. I know what I’m doing and why I’m doing it.” And you know what, some of you probably really do have things pretty in line, and I honestly think that’s terrific. Keep doing what you’re doing and you’ll have less of a chance of ever needing to come work with a hypocrite therapist like me.

But as for the rest of you righteous chin thrusting bicep-flexors, the ones of you that sort of know you don't have it all together but have a hard time admitting it: you’re scared of vulnerability, and that’s understandable—but the life that you’re living is driven by fear. Like literally, fear is sitting in the driver’s seat of your metaphorical life car.  Do you want that?

I’m also intuiting that there will be a segment of you out there who are thinking, “Well, crap. I know I value X but I spend a lot of time doing Y,” or possibly “I don’t even know what my values are.” What I want to say to you is: it’s okay. You’re human. And because you’re human, you’re not perfect and you’re never going to be. But you can learn more about your values and find ways to life your life in step with them.

Do you hear that compassion? I can readily dish it out to others, but have a hard time spooning even tiny bites of it to myself. (Another hypocrite therapist moment! Yay!)  I’m working on it, though. Moving towards showing myself empathy and accepting myself as (very) imperfect will be a lifelong process. 

Fortunately, even in accepting the inherent messiness of me and my life, there are some things I can do to get my shit a little bit more together. I can make a concerted effort to spend more time doing the things that I really care about, and that really bring joy to my life. That’s what this blog is all about, actually. Some things that I value are: creativity and new ideas, connection, authenticity, humor, compassion, self-care, and psychology/mental health/wellbeing (duh). This blog will be a venue for all of these pieces of me, a place where they can party and dance on the tables for awhile. They desperately want to, and I’m going to let them.

And that’s it. That’s the most cohesive thing I can say about this, my latest venture in cyberspace creativity.  I’m going to write about stuff that I care about. My only agenda is to keep writing—because that will be one sign that I kept trying.