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One Year In: COVID’s Messages for Psychotherapy and Society
Looking back over the last year of COVID and teletherapy.
Posted March 14, 2021 Reviewed by Kaja Perina
One year ago, I published "Coronavirus Anxiety: Should I See My Therapist Face to Face?" At the time, I was picking up on the messages on the streets and in my feeds, and most of my colleagues were pivoting very quickly to teletherapy. In the months thereafter, some of us have given up our offices entirely and considered doing virtual sessions from here on out, indefinitely; others (like me) are cautiously waiting for a transition back to doing primarily in-office therapy. A few colleagues, by choice, discomfort with technology, or circumstance of work setting, have continued masked in-person therapy for most of the pandemic. I take it for granted that we are all trying to provide the best care we can while also keeping ourselves and our patients safe.
What follows are some personal observations, again based primarily on my own experience and what I’m picking up from “the streets and feeds.”
- Psychotherapy practices have been a lot busier.
a. The twin pandemics of COVID and racial justice have uncovered and worsened distress, disconnection, alienation, isolation and the need for professional support and care.
b. Teletherapy has made it easier for many to get care. Demand has increased in part because of the removal of commuting obstacles.
c. Work From Home (WFH) has given many people more time (and reason) to get care.
d. The needs for care are still not being met. I’ve had a lot of people, veterans and military personnel, primarily, approaching me for free care via Give An Hour. We are clearly not close to meeting the need for free and low-cost care and personalized attention. Military personnel have had increasing suicide rates for the last seven years, with the Army showing a 30% increase in 2020 over 2019.
e. While there has been a lot of worry about medical staff burnout, I’ve only seen one physician through the Frontline Worker Counseling Project. My guess is that a lot of medical staff are doing the best they can, and we have a long tradition of stuffing our needs in service to others. But there will be a long tail to COVID stress. This will lead to both difficulty and insight for rebuilding stronger – if there are ears for what frontline workers say. Frontline workers absolutely need a sense of efficacy and hope that their work will ease suffering. That has been eroded, to say the least.
f. It's also easier for therapists and psychiatrists to just add patients. And become potentially overloaded. I've found that it's become more challenging to keep up with tasks like progress notes. Sessions have become more full, there's more going on, and everyone needs some time to let go between patients, which is harder if physical motion is limited. On the other hand, I find that my memory for my patient sessions from week to week is much better overall. I think I'm just paying deeper attention to life in general.
2. The Twin Pandemics have been “good.” Some people have in effect welcomed the opportunity to let go, drop down, and get in touch with what’s really important. So much of our workaday lives are about suppressing our feelings. But in the last year, we’ve had more time to be with our feelings and some have come to a deeper appreciation of who we are, what is needed, and what is at risk. This has certainly been true for me. My moral distress has expressed itself creatively, and hopefully helped others in writing here at Psychology Today and at East Wind eZine, in filmmaking, and in work with my compassion organization SF Love Dojo. I'm just trying to find life in the times. None of this takes the moral distress or suffering away. That will require all of society to let go and drop down into compassion, relationship, and deeper sense of purpose.
3. The Twin Pandemics have been bad. As I mentioned, the early indicators are that there has been increased distress and disconnection, in addition to suicide and homicide. Intimate Partner Violence has likely increased overall, and the lack of privacy has made getting help more complicated. Alcohol and substance abuse seems to have increased. Youth have lost social engagement and often educational coherence, and some have become victim to substance abuse, suicidality and mental health and relational/social challenges.
4. Technology has been a saving grace, but... Everybody who knows me knows how much Facebook annoys me. I published a whole book on social media in 2017. But I got back on Facebook, and found some occasional relief and connection there, though Zuck’s algorithm still doesn’t seem to like me much. Twitter has been wonderful, and an unexpected joy. Jokes and warmth abound with the right people. But the bad stuff I’ve written about social media still remain, especially for women who write about racism and sexism. It’s pretty gross and abusive. We really need a strategy to address the disconnections and sociopathy of the virtual realm that have steered too much and too many into chaos. Is it too much to ask for mental and social health reparations from Facebook and the internet overlords in general, for their downside effects? And needless to say, there is great disparity in access to technology.
5. My sense is that therapists who are more engaged and relational fared better during the pandemic, both in terms of personal mental health and in what they felt capable of offering their patients. Last year’s article in The New Yorker (Gopnik A. The New Theatrics of Remote Therapy, May 25, 2020) spotlighted the stresses on classical psychoanalysts in the early days of COVID. I’m not sure how they’ve adapted, or what insights have arisen from their work. My own personal insight is that it’s all in the relationship, and in cultivating the skills to build our therapeutic relationships in service to our patients. Would that our society would be able to learn from the lessons of suffering, in service of the great vulnerability and possibility of the human condition.
Conclusions
The bottom line is that I think this last year has been a bottleneck event for the evolution of psychotherapy, and the evolution of society more generally. We are in the midst of a multi-level, multi-system paradigm shift and what I hope will be a deeper level of organization – based not on power, control and hierarchy, but based on meeting human needs for safety, nurture, compassion, relationship, growth, knowledge and wisdom. It seems like a tall order – but it’s the kind of higher purpose that gives every last one of us something to do as we shuffle, anguish and cherish on this mortal coil.
(c) 2021 Ravi Chandra, M.D., D.F.A.P.A.
Check out the trailer for "The Bandaged Place: From AIDS to COVID and Racial Justice"—in submission to festivals now.
