As we approach our fourth week of confinement here in Spain, my work as a psychotherapist has taken on a new meaning. Ironically, despite working online, I feel closer to my clients. No matter how hard the content of our sessions, I come out of them feeling more human, more connected. Many of those I work with are isolated alone, their daily lives changed beyond recognition. And perhaps because of the universal nature of this shock, I feel as if the bones of therapy have been stripped bare: the very process of connecting, talking, being heard is in itself enough. The human dimension – and by this I mean the simple fact of our relationship – is forefront.
‘It’s showing us what a fragile construct mental health is. Mental illness is so societal, so contextual,’ a colleague said to me a couple of days ago. ‘Suddenly anxiety and fear are natural responses. The new normal.’ I think about this a lot as I work with my clients this week. There’s much being said in the media about the ‘new normal’ we will emerge to once the pandemic is over. It’s enough to terrify us all. Mass unemployment, economic collapse, closed schools, restricted movement, widespread surveillance, a non-existent high street – the list goes on. But I wonder if there is a bigger change occurring, too. ‘Life has no meaning the moment you lose the illusion of being eternal,’ to quote Jean Paul Sartre. Optimistically, perhaps, I wonder whether in place of ‘no meaning’ we might find a ‘new meaning’ in togetherness and community. We might begin to talk more openly about and accept the fear, anxiety and sadness within ourselves and help those who are overwhelmed by it. Being forced to slow down, while being exposed to daily death tolls and fear mongering, might push us to look at ourselves and others differently, more honestly, more compassionately.
I have clients for whom anxiety has long been an almost inescapable way of being. One of them was in such difficulty when she first came to see me, she wouldn’t eat for days. She was thin and brittle as an anorexic, taking cocaine and ketamine most weekends. She would appear every Thursday, huddled in the waiting room, a hat pulled down so low you couldn’t see her face. Time and time again she would tell me that therapy was her lifeline. It was how she was going to turn a corner. And turn a corner she did. When we meet today, we reflect that she is in a better place to deal with this crisis than she’s ever been in her adult life. She hasn’t taken drugs since last year; she’s come off antidepressants; she’s been going to the gym since January and is now exercising every day in her bedroom. She makes an effort to cook for herself and has put on a little weight. ‘I’m actually not feeling anxious,’ she says in our session, ‘I should be and everyone around me is, but I’m just feeling a bit low. I’d rather feel low than anxious. If I was anxious, I couldn’t do anything, couldn’t even sleep. I look at how my friends are coping – getting hammered, off their heads. That could be me. But it’s not me. I’m grateful.’
This preference for sadness over anxiety has struck a chord with me today. I think about how chaotic and utterly overwhelming anxiety can be. Almost like a demon that possesses us, stretching everything so tight it might snap: our voice, our nerves, our breath, our capacity to be present. I think about sadness, about depression. How it drags us down to the bottom, slows us to a stop. Anxiety sends us spinning; it freezes us at full pitch. I can almost understand her preference, though I have never thought of it in these terms. I underline the words in my notepad and I see a pattern: gems of wisdom are coming out of my clients’ mouths on a daily basis with this crisis. One client is so articulate this morning on the feelings I’ve been having about what the pandemic is teaching us, it’s as if she’s entered my own head. ‘Normal is out the window,’ she says. ‘Everything is a construct. We’ve never had this free time before; it’s got to change us.’
Another client has a friend with the virus who is in intensive care. ‘I know I said last week that life goes on,’ she says to me in our session, ‘But I’ve realised that life doesn’t go on. Not for everyone. That’s the reality.’ There is a sadness about her when we speak, but at times – despite everything that is happening – we manage a smile, a laugh. She tells me that yesterday she took her friend’s dog to the vet and made the mistake of telling the receptionist its owner was in hospital. ‘But I haven’t visited her in ages,’ she told the receptionist, when asked to wait out in the street. ‘I picked the dog up from her son, I didn’t even go inside. He let the dog out to me.’ This explanation did not reassure the receptionist. ‘So I went out and stood there and cried,’ my client says. ‘The woman was just doing her job, I know that. Why do I overreact? Why do I cry so easily? I didn’t cry when my sister died, but I cry at the smallest thing. I wish I could toughen up.’
It is a strange sensation for me, listening to her recount this experience. I can visualise the scene so clearly, almost as if it was me who took the dog, me with the friend in hospital. I can imagine myself having that very same reaction at the vet’s. It feels human to me to be so on edge, to be so sensitive considering what we are living through. I tell her this. ‘I can’t imagine you reacting like that,’ she says. ‘I can’t imagine you ever reacting like that.’ I very rarely share personal information with a client, but this time it feels appropriate. I tell her I didn’t cry when my mother died, either. I say I, too, cannot explain it, but often the big things are when we can’t cry. ‘I didn’t know your mother had died,’ she says. ‘I’m so sorry.’ We sit for a while in silence, looking at each other through the screen, a slight smile on our lips.
My youngest client lives with her parents and brother. She came to me suffering from anxiety and depression months ago. From the very beginning, therapy was as much about giving her the space to explore her experiences and feelings, as helping her to go out into the world to make her own way. When she came to therapy, she was spending all her time at home, much of it in bed. Gradually, things shifted. She got a job and was going to the gym until the confinement started. Now her anxiety has returned with a vengeance. She senses she will struggle to go out again once it’s all over. She enters our first online session, her eyes welling with tears. There are arguments at home – between her parents, with her brother. They’re driving each other mad. When I ask her to elaborate on the anxiety she’s experiencing, she says she feels constantly guilty – that she’s not a good enough daughter, she’s putting on weight, she’s regressed during the quarantine. I ask her to find the feeling in her body: where is it? What is it? She says it’s like a burning in her stomach. We do some breathing. Afterwards, she says it has lifted. She tells me about her brother: he failed two subjects at school and she’s been helping him catch up. ‘That’s nice,’ I say. ‘To have the time to help him.’ ‘It really is,’ she says. ‘I’ve realised how hard it is for him. He’s always compared to me. I was the perfect student. He struggles.’
‘There’s no room for FOMO anymore,’ one of my clients says. ‘I mean, who is there to envy? I didn’t even envy the Londoners who ignored how serious this is, going out to the pub when they were told not to.’ He says he’s been chatting with a girl he’s known for a while and really likes and he’s happy he can’t see her, because usually he’d be rushing to sleep with her. But now he can’t. ‘Maybe this has come at a good time for me. Maybe I needed it,’ he says. ‘Life has really slowed down.’
One of my clients is a doctor who has voluntarily flown back to her country of origin to work in emergency services. She is now stuck in quarantine for two weeks before being allowed to start at the hospital. We connect during this period. She’s been told there won’t be any protective clothing for her – they’ve almost run out. She’s struggling with the risk this poses both to herself and to her patients. She says, ‘If I was in this position a year ago, I’d have had a meltdown, but somehow, though I’m scared, I feel ready.’ Why does she think she feels ready? I ask. She has always been skeptical about therapy. She is a scientist through and through – she needs evidence things work. But today she says, ‘Maybe there’s catharsis in talking. I don’t really know what I think has done it. I’m feeling grateful for what I’ve got. More comfortable with who I am.’ Then she says, ‘What do you think has done it? How do you think therapy works?’
After our session, I find myself sitting down to write about therapy: what it is; why and how I think it works. I’ve often marveled that I am being paid to sit and listen, with my full attention, to other people’s most intimate monologues. I will never tire of the stories people have to tell. I will never run out of empathy for the trials they have endured. And although therapy is not just about being heard, I know this is a major part of it. There is something remarkably therapeutic in the opportunity it gives us to clarify and tell and retell our stories with a private witness who has nothing to do with our own lives. A private witness who, by their very calling, is there to help us clarify, and there to be on our side. So many of us are not heard – cannot even hear ourselves think. Therapy is a process of helping a person understand their own wounds; helping them understand their actions and reactions, too; allowing them to see and call out the core beliefs that drive them and that, perhaps, hold them back. In the systemic school, therapy is about seeing ourselves within a web of relationships that mold and drive us in ways we are often unaware. The attempt to define and describe therapy could go on and on, but I still maintain that fundamentally it is about being heard.
I write this and hesitate. I am missing something. There is something else I have tended to see as secondary to the ‘being heard’, and that now, during the Coronavirus crisis of isolation, I am seeing as primary: therapy is a relationship. Where other relationships might have let us down, this is a relationship that remains constant, reliable and prepared to face whatever suffering is thrown its way.
‘I’m the best I’ve ever been,’ says one of my long-term clients. ‘This is the sabbatical I’ve been dreaming of. I’m mentally so rested. It’s really weird. Around me everyone is getting depressed.’ He is relieved to have broken the boring routine of getting up, rushing to work, listening to podcasts, dealing with shitty company politics, rushing to the gym, feeling obliged to socialise. ‘I’ve realised I like this time alone,’ he says. It’s given him the space to reflect on what went wrong in his last relationship, too something he found challenging before. He can see how rigid he was, how much he had going on, how little time he had for her. ‘Why push yourself so much?’ he says. ‘Relax! Relax!’ I feel, for a moment, as if he’s talking straight at me. ‘People are so used to getting what they want, whenever they want it, all the time,’ he says. ‘Now we can’t. We just can’t.’ I tell him it sounds as if the experience is like therapy for him. Accelerated therapy. ‘It is,’ he says. ‘I can finally see my life from the third person.’
Tonight, I get a message from a doctor friend here who is working on the front line. ‘How are you? Are you going mad!?’ he asks. He says he feels like he’s living in a nightmare. ‘It’s the hardest work I’ve ever done, the hospital is full of pneumonia. Colleagues are sick, some have died.’ He tells me to expect it to go on well into May. And then he says, ‘Stay strong, healthy and isolated: the most important thing! Look after each other. Together we will get through.’