Love in the Time of Cholera, is Gabriel Garcia Marquez’s haunting novel maintaining love and hope through years of torment. It is inspired by Daniel Defoe’s Journal of a Plague Year. Marquez says YES; love, loyalty, hope, can endure, but great efforts are needed. What are the efforts we require in these times of Covid virus?
Love in intimate relationships can, but may not, withstand great and lasting hardships. For some people, love and loyalty deepen. For others, existing conflicts flare, old conflicts erupt, and connections are damaged or broken. All are confronting mental health base lines and specific psychological responses to anxiety and confinement. As therapists In these days of the virus, we are all being tested (I wish I meant tested for the virus; if only such tests were available!). What can we bring, remotely, to parallel the “holding environment” of the therapy office. And it holds both ourselves and our clients equally.
As Cozolino (2105) wrote in his many books on neuroscience and therapy, the therapeutic relationship has been proved stronger in mental health restoration and duration than whichever model of therapy (CBT, EMDR, DBT, Trauma-informed Therapy, etc., etc.) may be the designated approach. Rewiring of the neurological pathways that lead to or away from problems like impulsivity, aggression, depression, anxiety, and the like are the actual curative mechanism, and that mechanism is most powerful when the therapist is oriented toward psychodynamic practice per se. By psychodynamic practice per se I mean one on one, real time, provision of “therapy of depth, insight, and relationship.”(PsiAn, 2019). So where does that leave us as remote therapists?
There are patients who take to Zoom without a hitch. They may also Facetime. They rather like the freedom to be wherever for their appointments. No commuting, no waiting rooms, up close facial contact. While this enables continuation of an existing, or even development of a new treatment relationship, I think a lot is lost. For one thing, the client’s space is fluid, meaning lack of continuity in the holding environment. Also clients are “at home” in some fashion, which conjurs up any amount of unfinished business as well as present encounters.
There are patients who run away: This may be opportunistic, meaning addressing underlying transference and countertransference issues. New patients may be shopping because it’s easy to do in telehealth, or may be urgently seeking answers from an “expert” in a particularly limited way. This isn’t all that different from in-office work except our use of self may feel less accessible
The vast majority of people, which includes patients, therapists, and everyone else, is deeply affected in negatively psychological ways. The Washington Post (4/2/2020) reports on a national survey that ‘”The poll makes one thing clear: If you’re scared, anxious, depressed, struggling to sleep through the night, or just on edge, you’re not alone.” This poll, cited by Andrew Solomon in his article in the New York Times, with the headline “We are in a dual crisis of physical and mental health. But there are ways to head off breakdowns.” (4/9/2020). What are those ways?
Solomon cites his personal experience with “what is pathological and remediable. I know these unwelcome alleyways — and the paths out of them — like the back of my hand. It’s not that an antidepressant will make people unafraid of this mysterious and awful virus, nor that a single hug will mitigate their profound aloneness, but they can help.”
Solomon also endorses “fake it till you make it.” He urges us to think of being available to others as a strength and solace. That is what we as therapists are doing on zoom. We set aside our own struggles and are 100% present to hear our patients. This is a gift to us: the dislocation and re-location we are used to making as we enter our offices, the inner sanctum not just for the patient, can be translated to Zoom is we set it up that way. Have a special private place. Keep a schedule. Be a few minutes early to reduce technical mayhem that derails the start of a session. Keep notes. Put the notes away and don’t discuss your work other than with peers for supervision. It’s really what we’ve always been doing, but now we can replicate this boundary-securing ritual.
Now we need to replicate this caretaking regimen for ourselves. Again Solomon shares his personal solutions. “Being forced to deny depression can be a dangerous social tyranny, but choosing to vanquish outward signs of it for someone more vulnerable pulls me back from the brink. Partly in his name, I’ve adjusted up my meds and am in contact with my therapist, and I make sure to hug him and hug my husband, knowing that all three of us save one another… I take a daily walk through the woods with my son and our dog. Sometimes, my son and I jump on the trampoline, which, despite jolts to my back, is immensely physically cozy. My husband, my son and I pile in together to watch a movie every night; my husband is also obsessively reading books about epidemics, from the Black Plague to the 1918 influenza pandemic, and teaching himself Portuguese online. We all find comfort in our own curious ways.”
Love in the time of Covid means self-love and patient-love and interpersonal love for whoever we contact. That we have to convey this availability and openness on the internet, the components do not change.
Relationships Can human empathy and connection fill the void left by the loss of external hurly burly life: jobs, children, social expectations, chores, household management, and all the rest that fills our days?