Covid in the Consulting Room: How My Therapy Practice Has Changed
Therapist Sue Cowan-Jenssen reflects on how Covid-19 has changed her therapy practice, both in terms of moving online, and in terms of her work with clients
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The threat of the virus entered the consulting room as nothing in my experience has ever done before. 9/11 and terrorist attacks in London might have initially compared but their impact didn’t last.
I work from a relational perspective. I believe that there are always two people in a room who impact each other. Whilst we have different histories and different roles, ultimately we share the experience of being mortal. We all live our lives against the reality of death. Of course, we deal with it or don’t deal with it in different ways. At no time has this felt so true. Of course, some of us will have very different experiences. I am not looking after a sick partner, or indeed young children. I have not lost my job.
But as a therapist, I do have to expose myself as vulnerable and this might be disturbing to a client who hopes I am immortal. It also is a challenge to us therapists who are not averse to feeling a bit ‘immortal’.
Interestingly, my clients now almost always start out our sessions, with asking how I am. It is an acknowledgement of mutual vulnerability and perhaps gratitude we are still looking at each other, albeit on a screen.
Initially when I moved to online work, I didn’t really like it. It felt harder and I found it more tiring. Quite quickly I adapted and I find I am enjoying working sessions again. The first few weeks were full of how people were coping or not coping with the lockdown including myself. There were the surprises that some people were really enjoying the quieter pace of life. I got many questions about how I was coping. I would answer honestly, that I was grateful to be able to continue my work, but I desperately missed running across the road for my cup of coffee.
Covid has meant different things to each of my client. I think of one client, let me call him James. He lived in a shared flat with another young man. Initially he was obeying the lockdown rules but quite quickly he started getting careless and taking risks. His flat mate, who had some health anxieties of his own got very angry with him. After James met up with some friends, his flat mate became cross and shouted at him. James felt angry and ashamed. He knew his flat mate was right to be angry but his sense of shame made him defiant. He had a history of a controlling mother and he hated that he had ever submitted to his mother’s arbitrary ‘rules’. What became clear in our session was how his ‘defiance’ was hiding his own anxieties about the virus. He had had quite serious health issues as a child and in fact this was quite a factor in his mother’s controlling behaviour. His mother saw him as a fragile child and his recklessness covered the shame that he could be vulnerable and was indeed frightened.
The pandemic is challenging us all on so many levels. It is a challenge to live in a time of great uncertainty with little respite in sight. Anxiety can be profound and often we will catastrophise because if you believe in the worst, then at least the uncertainty is over.
Hope is uncertain and difficult to hold onto at the best of times and this isn’t the best of times. When we constantly fear the worst, it starts to feel more real than anything else. Optimism is surely foolhardy and reckless. We might fear disappointment if we are hopeful. But hope is important for our mental health and so we aim not to be foolishly optimistic but not to be overly pessimistic either.