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 "Being Vaccinated," as a therapist deals with her patient's aversion to receiving the Covid19 vaccine, the patient-therapist relationship comes to the fore, as does the question of caring and being cared for.

“So I know I’m locked in the house like everyone else and hating it and ready to strangle my husband, but I really need to talk to you about my daughter. She’s driving me crazy,” Paula says, barely stopping for a breath. “She just doesn’t stop. ‘Mom, did you get the vaccine? Have you tried getting the vaccine? Have you signed up through the Department of Health? Did you try your local grocery store? What about Dad?’ She doesn’t stop. You have to tell me what to do.”

Paula, who I’ve only ‘seen’ for a few sessions via the telephone, is a seemingly headstrong, stubborn, opinionated 67 year old woman. “What should you do about…? I ask.

“About her of course! What should I do about my daughter constantly bugging me?”

“What have you done?”

“Nothing.”

“Nothing? But what do you say to your daughter when she asks you about being vaccinated?”

“I just put her off, you know, like saying ‘not yet’ or ‘it’s not in the area yet.’”

“Do you plan to get the vaccine?”

“Not if I can help it!”

“Because…?”

“I’m not into being a guinea pig! Who knows what the government is putting into those vaccines? How do we know they’re safe? They’re so new. Maybe they’re giving it to all us old folks first because they think we’re disposable. Who cares if some old people die! I didn’t trust Trump and I don’t trust Biden any more.”

Although I knew that Paula was distrustful of others, I hadn’t recognized the extent of her suspiciousness. I tread carefully. “So why haven’t you told that to your daughter?”

She scoffs. “My daughter’s a doctor. She’ll laugh at me and tell me I’m crazy.”

Although I find myself agreeing with my patient’s daughter, I stall for time by asking an inane question. “What does your husband think?”

“He doesn’t care. He’ll do whatever I say. We’re both healthy. I mean I know we’re both over 65, but we’re in good health. Why take any chances?”

“And yet you’re comfortable taking your chances with Covid?”

“Maybe.”

“I’m sorry. I’m not sure what you mean.”

“How do we know the whole thing isn’t a hoax? Maybe there is no Covid. Maybe it’s all just a big scam.”

“And what would be the purpose of this scam?”

“I don’t know. Maybe to try out these experimental drugs for some future disease, some other virus that strikes 25, 100 years from now. Who knows.”

I sit with my anxiety for a moment until what I hope is aninspiration strikes me. “You know, Paula, since you’re so reluctant to share your reservations about the Covid vaccines with your daughter, I’m impressed that you feel comfortable telling me about them.”

Silence. The silence continues.

“Paula, are you there?”

“I’m here.”

“Okay. Good.”

Silence.

“I’m supposed to tell the truth here, right?”

“Yes. That’s definitely helpful.”

“Well I know this sounds terrible, but I can tell you because you don’t matter. My daughter matters to me. What she thinks of me matters to me. What you think of me doesn’t matter because you don’t matter to me. I pay you to give me a service. Beyond that you’re irrelevant. Does that sound terrible?”

“Well,” I say cautiously, “it’s definitely honest.” I pause, trying to gather my thoughts and think of an appropriate response. Speaking softly, I say, “I wonder what it means that I don’t matter to you, that you can so easily dismiss me as irrelevant. I wonder who in your life has made you feel you don’t matter. I wonder if you yourself feel you don’t matter. And I wonder if one of the reasons you’re so suspicious about the virus or the vaccines is that it’s hard to believe that anyone could feel you’re important enough to care about.”

“Are you saying I should care about you?” Paula responds, understandably not able to take in what was a long, complicated interpretation.

“Only you can answer that.”

“Well, I don’t know if I can or if I should care about you.”

“I understand. I think perhaps our first questions should be whether you’re able to care about you and whether you’ve felt cared about by important people in your life.”

“You mean like my parents?”

“Yes. As well as others.”

“I told myself I wasn’t going back, that I wasn’t going to dredge all that stuff up.”

“Yet you chose to see me, a psychoanalyst, so perhaps part of you wants to dredge all that stuff up.”

“Nonsense!”

“But we’re meeting again next week, right?”

“I suppose,” Paula responds grudgingly.

“I’m glad to hear that. I’ll talk to you then.”

a patient and therapist as they work to understand how the patient's past led to her blunted response to the storming of the Capitol.

I don’t get it,” Marlene begins, her face appearing tense and puzzled on my screen. “Every time I talk to one of my friends or even exchange an email, they’re talking about how devastated they still feel about the storming of the Capitol. I agree, go along with it, so they don’t think I’m some sort of a weirdo, but I don’t get it. It was a building for God’s sake. Yes, 5 people died and I’m sorry about that, but I see people dying of Covid every day in the hospital, people who are scared and alone and broken. We’ve lost way more than 300,000 people to Covid and people are so distressed about a building! What’s the big deal?”

I’ve had many patients who were very distressed by the events of January 6, others who, not surprisingly to me, didn’t even mention it. But I am surprised by Marlene’s lack of emotional response. As a nurse she has been on the front line of the pandemic, so perhaps, I think to myself, she can’t allow herself to feel any more pain. Still, politics matters to her. She usually has very definite opinions, often accompanied by intense affect.

“It sounds as though you’re uncomfortable with your not experiencing it as a big deal,” I suggest.

“I suppose. I don’t know, it just makes me feel different. Which is certainly not a new feeling for me.” She sighs. “Poor white trash, daring to want to make something different of myself. That got me beaten at home for thinking I was better than them and bullied at school because those kids sure as hell didn’t think I was as good as them. Shitty beginning.”

“And you’ve taken yourself far from those beginnings.”

“Yes. And I haven’t told you, but I’ve been thinking of applying to school to be a Physicians’ Assistant.”

 “That’s wonderful, Marlene. I’m so pleased for you.”

“You don’t think it’s crazy? I’m already over 40. And PA school is very competitive.”

“You know, Marlene, I think you just asked me if I think you’re being too uppity, going too far from ‘home,’” I say.

She chuckles. “I think you’re right.”

“So do you think it’s weird that I don’t feel more about the storming of the Capitol?”

“I don’t think it’s weird, Marlene, but I do think it’s unlike you.”

“So you had strong feelings about it.”

“I did. But I’m wondering right now why you are asking me all these questions rather than telling me more about what you’re thinking, what you’re feeling.”

“I guess I’m feeling weird, which takes me back to my childhood.”

“What specifically in your childhood?”

“All of us living in that three room house. All the screaming. All the violence. My Dad beating the shit out of me if he found me reading a book. All the kids at school circling me, jeering at my clothes.” Marlene’s eyes fill with tears. “Will those images ever go away? I want them to go away.”

“Let me ask you something, what brought those images back so vividly?”

Marlene’s eyes widen. “Oh my God, seeing those people storm the Capitol! That’s what brought those images back. Those were quote, unquote, ‘my people.’ Oh my God,” Marlene says sobbing. “Oh my God! It’s so awful! Of course I couldn’t take it in. It’s way too close, way too close. It makes me sick. I don’t want to be like them, I don’t, I don’t.”

“You’re not like them, Marlene. You’ve grown a long way from there.”

Marlene continues crying, tears streaming down her face as she stares at me on the screen. “I wish I was in your office right now. I wish I could feel your presence, like your presence would erase the awfulness of those images.”

“I wish that too, Marlene. But I do hope you can feel that I’m here for you.”

She nods. Grabbing a tissue, she blows her nose and wipes her eyes.

“So I couldn’t take in the horror of the mob attacking the Capitol because it brought me too close to my childhood experience? So I did what, I shut down, and didn’t allow the horror to penetrate?”

“I’d say that’s exactly what you did, Marlene. At first I thought you’d shut down because of all the months of dealing with the stress of Covid meant you couldn’t take in one more horror. But I’d say, you got way closer to the real reason you shut down, the need to distance yourself from the horrors of your childhood.”

Tag words: Psychotherapy, mental health, defense, patient-therapist relationship, childhood, violence, growth, ambition, numbness, shutting down.

a patient and her therapist seek to understand why this troubled, depressed patient is faring better than usual during Covid and its restrictions.

“I realized the oddest thing this week,” Anne begins, her voice fairly upbeat as she speaks into the telephone. “I’ve been feeling okay.”

“That’s terrific, Anne,” I say excitedly.

“Yeah, I’ve been talking to you for how many years? And this is probably the first time I’ve ever said I feel okay. I can’t figure out why. Nothing has changed. I’m stuck indoors like everyone else. Our Covid numbers are spiking, I’m as terrified as ever of getting the virus and yet I’m okay.”

Anne is correct. I have been speaking with her for a number of years and this is probably the first time she has not described herself as depressed, anxious and isolated. We began working in person when she relocated to Florida to take care of her aging and always demanding mother, a long and arduous process that called upon all the strength Anne could muster and all the support I could give. After her mother died, Anne returned to New York, saying it felt like home, although she had neither friends nor career to return to. She did, however, now have sufficient money to live comfortably whether or not she could find a career path commensurate with her intelligence and education, leaving behind her unsuccessful attempts in retail or restaurants.

“What are your thoughts?” I ask.

“I don’t know. I’ve done the same thing these past several weeks as I’ve done for months, or even years, and I feel strangely content. No despair, no pressure. Of course I haven’t had any pressure for a while, not since my Mom died.”

“Except for the pressure you put on yourself.”

“That’s true.” Pause. “I still feel I should figure out what to do with the rest of my life. I should be looking at various career possibilities, seeing what piques my interest. But I guess I know what the reality is with Covid. New York is decimated. There are thousands and thousands of people unemployed, stores are boarded up. No one is going to hire a 52 year old woman who has probably never held a job for more than a year. I also feel I should go back to my painting. I was pretty good at it. Why don’t I spend my very excessive amount of free time painting again? I should. But I don’t.”

“So you’re still putting pressure on yourself.”

“Yes” Pause. “And I do still hear your voice telling me I should be spending more time with people. But of course everyone is told not to spend time with people these days. But I know you’d still be telling me I should at least reach out to my sort-of friends by phone.”

“You still feel pressure from both yourself and me, but you feel different, calmer, less despairing.”

“Yes.”

“And you don’t feel isolated?”

“Everyone feels isolated.

“Maybe that’s comforting.”

“What’s comforting?”

“That everyone feels isolated.”

“That’s a good point. I don’t have to feel like such a freak.” Pause. “Yeah, that’s right. Usually this time of year would be the worst. Thanksgiving in November, Christmas and New Year’s in December. Everyone running around buying food and presents and looking forward to seeing family and friends. And then there’s me. Sitting at home stuffing myself with junk food and wondering if I should kill myself. But not this year, this year everyone’s in the same boat as me. I know they still have these ridiculous TV commercials with people sitting around a big table together or drinking themselves sick at parties, but now they look exactly like that – ridiculous. No one should be doing that this year. Everyone should be doing exactly what I’m doing, sitting home alone, no one else there. Yes, it’s a tremendous relief. That’s exactly why I feel okay.”

“Where do I fit in?” I ask.

“You’re my one exception. You’re here. But of course you’re not here. You’re thousands of miles away.”

“And that means what for you?”

“Actually makes me feel a little sad. But not too much, because I know even if you were next door we’d be meeting just as we are now, on the telephone. Yes, that makes me feel better immediately. So I guess that’s another thing Covid has done for me – made me feel less like a freak and made our distance feel less significance. No wonder I feel better.”

Anne may feel better, but I’m left feeling sad, both for the sadness she likely feels underneath her “better,” as well as for the isolation she wears as a protective shield, unable to breach the chasm between herself and others. Covid will eventually end and unless we are able to breach that chasm she will return to feeling like a freak, the forever outsider longing to be part of the lives she only imagines.  

Tag words: Psychotherapy, mental health, patient-therapist relationship, projective identification, isolation, sadness, despair, aloneness, Covid19.

"In Mourning," a patient returns to therapy after the death of his mother, struggling with a depression he cannot shake.

“Well, I’m back,” David says morosely. “I thought I could at least make it a couple of years without seeing you, but there’s no way. I can’t stand myself any more. I knew I’d have to see you virtually too, which only makes it worse, but I just can’t get myself out of this depression.”

“Do you know what’s gotten you so depressed?”

“Yeah, my mother died of Covid in April.”

“I’m so sorry, David. Yet another victim of the pandemic.”

“Yup! I mean, I know my mother was 92, and her health wasn’t the best, but she still had all her marbles. And of course, just like in the news, she died alone in the facility.” Pause. “I feel so incredibly depressed. And you must think I’m nuts since I had such a difficult relationship with my mother. You’d think I’d be, I don’t know, relieved, or something.”

“What do you feel?”

“But when you were a little boy, you felt your mother as the only loving presence in your house. And she was a huge protector. She protected you against your father, she protected you against your older brothers.”

“But I’m not a little boy any more.”

“Except that you carry that little boy inside you as an adult, just as we all carry our child selves with us.”

“So you think that’s why I’m depressed?”

“I think you’re in mourning so it’s not surprising you’d be sad, but the depression seems as though it’s more than that.”

“So what it is?”

“You know, David, it’s interesting that you look to me to tell you what your depression is about. That may be another indication of how lost you’re feeling, looking to me for answers that reside in you.”

“That’s true.” Pause. “I want you to tell me what’s wrong and make it go away. I know therapy doesn’t work like that. But it’s like I’m too depressed to even do the work I know I have to do.” Pause. “Please help me.” Pause. “I sound like a sniveling baby!”

“Well right then, you sounded like your Dad berating you, rather than being able to have compassion for yourself.”

“That’s true!”   

“So you’re mad at yourself for feeling depressed.”

“Definitely. I thought we fixed me. That my depression would be gone forever.”

“So, David, do you think you’re also mad at me? Mad that I didn’t fix you.”

Hanging his head, he nods. “Yeah. When my depression came back, I started questioning whether therapy had made any difference at all. When Covid first hit I felt very different. I felt that as was coping with all the stress and insanity and that I was a good support for both my wife and daughters. In the beginning we were all living together. My daughters came back from college, my wife was teaching from home, and I was doing my accounting from home too. It was kind of crazy, but sort of fun too. Felt like we were whole, a big, happy family again.  And I wasn’t allowed to see my mother so that took away my worry about whether too much time had passed and whether I had to go see her. Now my daughters are back at college, although they’re still doing most of their courses virtually, my wife is back teaching and I’m back in my office although I still meet with clients virtually. And obviously my mother is dead so I don’t have to worry about seeing her.”

“Sounds like you are feeling a lot of loss, not only of your mother, but also your big, happy family.”

“So there’s loss everywhere.”

“Definitely.”

“I notice though, that as soon as you acknowledged your anger at me and your lack of compassion towards yourself, you were able to start doing to the work, start looking at what was going on in your life that’s been contributing to your depression.”

“That’s true.” Pause. “I just wanted to ask you if that means I’ll stop being depressed.”

I smile. “I think with the loss of your mother, it’s easy for you to want to put me in the place of the mother who can make everything all right. I’m sure you have lots of feelings about your mother’s death, as well as issues about the inevitable passage of time.”

“Just hearing you say that made me depressed again.”

“I’m sorry. But sounds like that’s an issue we’ll definitely have to address.”  

Today's blog, "In A Quandary," focuses on a patient who returns to treatment to deal with the stresses imposed by Covid19, stresses that necessarily tap into past conflicts and issues.

“It’s kind of weird starting therapy on FaceTime,” my new patient, Leah, begins. “But I’m a therapist myself, getting used to working virtually, so I figured it was time to get myself back into treatment. I certainly could use the help.”

“And how can I help you?”

“I guess the big push for me to start treatment again is my father, but of course like everyone else in the world, I have problems and problems and more problems.” She sighs. “I’m 45. I’m married, my husband, Ed, is an IT guy working from home. I have two kids, girls, 12 and 14, who are in school virtually. So there we all are at home, each in a separate room, learning, seeing patients and solving computer problems. Sometimes it works, sometimes it doesn’t. It’s a problem if one of my girls doesn’t understand something she’s being taught and thinks she can just interrupt me in a middle of a session. I’ve tried to explain she can’t just do that, but if she goes to Ed, well, he just doesn’t have the patience, so she’ll end up interrupting me anyway. I’ve tried locking my door, but Elisa – she’s my youngest – gets really scared if I do that, so that doesn’t work either.”

“Sounds like you’re being pulled in every direction.”

“That’s for sure. And then there’s my father. My Mom died three years ago and at first I thought my Dad would be okay but now I can see he’s starting on the road to dementia – actually getting worse faster than I would have expected - and I’m worried about him being alone. Sometimes he calls again and again to ask the same question. He told me he’s burned a couple of pots forgetting he had the fire on. He’ll sometimes forget which apartment is his. And, of course, like many people during Covid, he’s lonely and, because he’s who he is, he’s angry. So I’m trying to decide if I should move him into the house with us.”

“Wow! Sounds like you have a tremendous amount on your plate.”

“Yeah. And the added problem is that I don’t like my Dad. I mean I love him – I guess – but I don’t like him. He’s angry, opinionated, narcissistic, dogmatic and intrusive. And that was all my life, not just since my Mom died or since the dementia.”

“So what was it like for you growing up?”

“Well, I’m a therapist, that should give you a big hint,” she says with a small smile. “It was hard. I was the oldest of three girls. My Mom was this really sweet person who didn’t have a backbone. She accepted anything and everything my father did, worshipped him really, and left us to fend for ourselves. Which usually meant I was the one arguing with him. My middle sister was the good girl, kind of like my mother, and my youngest sister just sort of floated through life, which is kind of what she’s still doing. I think she just ended marriage number three and career number … I don’t know. Too many to remember.”

“So what do you think it would be like with your father in the house?”

“Awful. I know it would. My youngest daughter is scared of him, always has been; and my oldest, at 14, she’d probably be arguing with him just like I used to. But I don’t know how they’d do with his dementia.”

“You haven’t said much about your husband.”

“I know,” Leah says sighing. “It’s hard. I mean I love Ed and I know he loves me, but even after all my previous therapy, I still think I married my father. No, that’s not really fair. Ed isn’t an angry bully like my father. But he is self-centered and not inclined to go out of his way to be patient or helpful, like I was saying before about his not helping my youngest with her schoolwork.”

“I notice you keep referring to your children as ‘yours’ rather than ‘ours.’

“That’s true. They’re very much my responsibility. I mean he loves them and he’s great about playing with them as long as it’s something he enjoys. But he’s definitely the fun parent and I’m the one who keeps after them to do their homework, pick of their rooms and so forth.”   

“So you always end up in the role of the responsible one. Any idea why?”

“First response, I was the oldest. Second, it’s the only way I’m sure things will get done.” Pause. “Maybe it’s the only way I feel safe.”

“There’s certainly a lot there for us to explore there.”

“I want to ask you before we stop if I should take my father in, but I know you can’t answer that.”

“Maybe we first need to look at why you only feel safe when you carry all the weight of responsibility.”

The convergence of 9/11 and Covid-19 and illustrates how a therapist tries to help her patient understand how the terrors of his childhood contribute to his fear in the present.

“Is it all right that we’re meeting on FaceTime today?” Jason asks.

“Of course,” I reply.

“You didn’t mind that I called and asked if we could?”

“No. But why are you sounding so tentative, scared.”

Jason drops his eyes. “It was 19 years ago today,” he says softly. “I was 25 years old. Seems impossible I was ever that young. But it also seems impossible that 19 years have passed. All I accomplished was that I got out of New York. But I’m as terrified today as I was then. At least then it felt as though there was an escape – get out of New York and your chances are way better. Now, now it doesn’t matter where you are, you’re doomed, subject to the whim of a virus. I’m tired, tired of feeling frightened.”

“I believe you, Jason. You were terrified during the 9/11 attacks and you’re terrified again. And, of course, we can’t forget that you were terrified your entire childhood.”

“I know you keep saying that and it’s true, but this is real! There

is this deadly disease out there that can strike anyone at anytime and there are a bunch of idiots who don’t think they should be wearing masks. Who wouldn’t be frightened?”

“Do you feel your childhood terrors weren’t real? An explosive, alcoholic mother who would beat you with a strap. I’d say that’s pretty real.”

“But that was then. That’s not what I’m living through now.”

“You may not be living through that now, but you are living with it. Those memories, those experiences are always with you.”

“I suppose.”

“Jason, why do you think you were so tentative about asking me to meet on FaceTime, why you had to check to see if it had been okay to call?”

“But you said it was all right,” he responds, tremulously.

“What are you feeling right now?” I ask softly.

“I just want to be sure it was okay to call, okay to ask for something different,” he replies, staring at me intently.

“Are you frightened of me right now?”

“I… I don’t know.” Pause. “Can you just tell me I didn’t do anything wrong?”

“Of course you didn’t do anything wrong. What you’re showing both of us is how easy it is for you to become frightened. You’ve put your mother’s face on me and are afraid I’ll be just as scary and irrational as her.”

Silence.

“I was thinking of that time I was, I don’t know, maybe 12, and my sister had a bunch of her friends over. My mother got mad at me for something, I don’t remember what.  She started to throw out my comic book collection. I was really into comic books. She took one bunch of comic books after another and took them to the dumpster. I was hanging unto her leg and crying and begging her to stop. Right in front of those girls. Then she took the belt and started beating me. She was like a crazy woman. I begged and cried and screamed. I was so humiliated.”

“Oh Jason, that’s such a sad story. I’d just want to hug that little boy and tell him it will be all right. I wish you could hug that little boy and feel for the terrorized child in you.” Pause. “Your mother is like the 9/11 attacks and the virus rolled into one.”

“So you’re saying that’s why I feel so frightened.”

“Yes, just like you became instantly frightened of me when you thought I might just possibly be angry that you’d asked for a change in how we meet.”

“I get that in terms of you, but the virus is real, it’s scary. Shouldn’t everyone be frightened?”

"Certainly everyone should be concerned with their safety and the safety of others. But beyond that, and I’m not talking about the politics surrounding the virus, beyond that, how people feel about the virus depends a lot on what they bring with them from their childhoods. If children grew up in a basically safe and loving environment they’re more likely to feel things will work out okay, that they won’t be harmed. That doesn’t mean they won’t be harmed, but they don’t feel terrified every minute of every day. On the other hand, if a child grew up in an environment where one or the other parent was anxious all the time about some unknown danger, that person is likely to be a more anxious and frightened adult. And growing up as you did, where anything really bad could happen at any moment, well that’s going to lead to where you are today, scared and waiting for catastrophe to strike.”

“But what do I do about all that? I can’t redo my childhood.”

“What we have to do is allow you to feel all the terror you felt as a child and then get to a point where you can take in that you’re no longer a child, that you no longer have to be afraid of your mother, not the real one nor the one that walks around in your head.”

Tag words: psychotherapy, mental health, patient-therapist relationship, transference, Covid, fear, terror, childhood.

“I know I keep saying the same thing over and over,” David says, his despair and anxiety apparent even over the telephone, as all our therapy sessions are conducted these days. “I feel scared all the time. I’m sure Covid is going to get me. I’m sure I’m going to die. Yet it helps me to tell you. I mean I know you can’t keep the virus from killing me, but telling you makes me feel at least a little better.”

“Do you know why telling me helps?”

“You’re the only person I can tell. My wife doesn’t want to hear it any more. She says I’m a 48 year old man who rarely leaves the house, so how likely am I to get Covid. She’s just fed up with me. And I try not to talk about it in front of the kids. I don’t want to scare them. But I’m so glad they’re not going back to in-person school. I don’t know if I could have tolerated having them go into a classroom every day and then came back home.”

“So is it that you feel less alone when you talk with me?”

“Definitely.” Pause. “I’ve always been afraid of dying. Even when I was a kid. If I saw a dead bird, I’d cry and cry and not be able to sleep for days. I was sure that would be me. And when my cousin enlisted in the army, I was in shock. I couldn’t imagine how anyone would volunteer to be killed. But this, this is the worst it’s ever been. There’s this disease that’s killing hundreds of thousands of people. It makes complete sense that I’ll be one of them.”

“It makes complete sense because…?”

“Because I know I’m going to die.”

“And what does knowing you’re going to die mean to you?”

“What!?”

“What does knowing you’re going to die mean to you?” I repeat. “We are, after all, all going to die.”

“You say that so calmly.” Pause. “Of course I know we’re all going to die, but that terrifies me. And it removes all meaning from life. Why bother being in a marriage, having kids, being successful? In the end it all goes away.” Pause. “I know we always go back to my father’s heart attack when I was seven, but even then I was amazed that he was able to come back from that and throw himself back into the business as if he hadn’t been on death’s door.”

“But that wasn’t your mother’s reaction.”

“Oh no, not at all. She hovered around him like he was about to die at any second.”

“Just like she hovered around you when you were sick,” I add.

“That’s for sure. She was an anxious mess. All I had to do is run a slight fever and you’d think I was dying.” Pause. “I know we’ve talked about this before. You think that my mother’s over-reaction to my being sick is why I always think I’m going to die.”

“Well, maybe it’s not quite that simple. How did you feel about your mother’s reaction to your being sick?”

“I don’t know. I guess I kind of liked it. Made me feel like she really loved me.” Pause. “Especially after my father’s heart attack, she paid way less attention to me, so it was nice having her focus on me again. And actually it drove my father crazy. He’d say that she was babying me, that all I had was a cold or a sore throat or whatever and that I’d be fine. I remember, he’d say, ‘Stop treating him like a baby.’”

“So when your wife doesn’t want you to talk about your fears, what do you feel?”

“Ignored, I guess.”

“Unloved?” I ask.

“I suppose. But I’m not really sure how much my wife loves me. Ever since we’ve had kids, she’s way more focused on them than on me.”

“So you felt you lost your mother to your father and now you feel you’re losing your wife to your kids.”

“Yeah! That’s right.”

“And what about me?”

“You?”

“Um hmm. You said I’m the only person you can talk with about your fears.”

“Certainly the only person who will listen.”

“And that makes you feel how?”

“I guess it makes me feel like you care.”

 “So maybe you learned early on that the only way to feel loved was to be sick.”

“But I could be sick without dying.”

Silence.

“I just thought of something,” David says. “Maybe dying is my punishment, my punishment for being such a baby and wanting Mommy’s attention.”

“That’s a great insight, David. We’ll talk about that more next time.”

A patient's early loss makes working remotely painful, creating a yearning for in-person contact with her therapist.

“I’m sitting in your parking lot,” Laurie says barely whispering into the telephone.

I consider asking her why, but I know the answer. Instead I say, “I’m sorry.”

“Not even your car is here. I thought maybe I’d at least see your car.”

“You know I’m working from home, Laurie.”

 “I know. But I thought maybe I’d get lucky.” Pause. “How long is this going to go on?” she asks, plaintively.  

“I don’t know. No one knows the answer to that.”

“But you could see me. We’re not under lockdown. I can eat in restaurants. I can have my hair done.”

“That’s all true, Laurie, but it doesn’t feel safe to me for us to be behind a closed door in a small space without a mask.”

“I know. I know. We’ve been through this a hundred times before. But I have to see you! I have to! I have to know you’re really here!”

“We did try FaceTime.”

“That’s worse. That’s like you’re here and not here. I don’t know. That totally spooked me. Then you really aren’t real. It’s almost like you’re a figment of my imagination. Like I willed you onto my phone. Flat. Way too flat.”

“Flat or dead?”

“I know you keep going back to that.” Pause. “Maybe. I don’t know. I went off to school, came home and my mother was dead. I’m sure that did a number on me. Oh yes, and by the way, she killed herself.”

“You’re talking about that horrible time almost like it happened to someone else.”

“I don’t want to feel that now! I’m too sad, way too sad, why would I want to start feeling about my mother offing herself?”

“Maybe because you are feeling it. Maybe because every time you pour over the statistics about how many people have died and how old they were and where they lived, you’re actually mourning your mother again and again.”

“Don’t I ever get to have mourned enough?”

“I think there are always times that losses in the present trigger past losses, especially when that loss was so primal.”

“How about if I met you in the parking lot for a session? At least that way I could see you.”

“And what? We’d both sit in our cars and …” I stop myself. Giving Laurie the practical reasons why her suggestion won’t work is not what’s needed here. “You know, Laurie, it strikes me that you’re trying to undo your mother’s death. It’s as though if you figure out a way to see me, to erase the missing, to erase the absence, then that will magically make everything all right including bringing your mother back to life.”

Silence.

“What do you feel if you accept that we’re not going to see each other for some indefinite period of time?” I ask.

“Angry!! Angry, angry, angry! Because it’s only an indefinite period of time because you’re making it an indefinite period of time. It’s you, you, you!! You’re doing this.”   

“Just like your mother killed herself.”

“Right! Who the fuck has the right to kill themselves and leave behind a six year old child? It’s not right! It’s not fair,” Laurie says sobbing.

“No, Laurie, it’s definitely not fair,” I say softly.

“Okay, so I’m mourning now, are you happy?”

“I’m definitely not happy you’re in pain, but you know I always think it’s best for you to feel whatever it is you’re feeling.”

“I want to see you! I want to see you! That’s what I’m feeling.”

“I’m sure that’s true. And I’m sure that’s what you were feeling as a child as well.”

“Fuck you! Leave me alone.”

Silence.

The silence continues.

I hear Laurie crying.

“I’m here Laurie,” I say quietly.

“You sure?” she whispers.

“I’m positive.”

“I used to make believe that I was talking to my mother on the phone, like she’d taken a trip somewhere and was missing me and couldn’t wait to get home to see me. Isn’t that pathetic?”

“No, Laurie, that’s not pathetic at all. It’s totally understandable and very, very sad. Don’t you feel for the little girl who was you who wanted her Mommy to come home?”

“I guess. Sometimes.” Pause. “And sometimes I just want her to stop being such a baby. I guess like I should stop being a baby when it comes to wanting to see you.”

“You’re not being a baby. You’re yearning for what your mother took away from you and what you feel I’m taking away from you too.”

“But you’re really here, right? I’m not just imagining you and I will get to see you again sometime?”

“Yes. I’m here. And we will see each other again.”

The problem many therapists face as the pandemic continues to rage and patients seek relief from their anxiety, depression and isolation.

Hello,” I say to an attractive, dark-haired woman who appears before me on FaceTime. “I’m glad to meet you.” And so begins my first experience beginning therapy remotely.

I practice in Florida, one of the states that is seeing a sharp uptick in Covid-19. Although I have toyed with the idea of returning to in-office sessions, I continue to find myself reluctant to do so. During the initial phase of the pandemic, I turned away new referrals, uncomfortable starting treatment with anyone I could not meet at least once in person. But as my time away from the office continues, I decide I need to go beyond my comfort zone.

“Hi,” Jennifer replies. “This already feels weird. I’ve been in a lot of therapy, but obviously in person. I kept thinking I’d wait until I could go to your office, but who knows when that will be, and I’m having a really hard time.”

“It feels strange to me too,” I say, “But why don’t you tell me how I can help you.”

I watch her take a deep breath. “I’m 49, I’m alone, I’m terrified of the virus and I just found out that my ex-husband has lung cancer. And that he hasn’t told our daughter yet. I’m so anxious I can’t stand myself.”

“That is a lot.”

“I’ve always been afraid of being alone and now I’m alone all the time. I mean, I talk to my daughter, but she’s in New York and she’s had a really hard time so I don’t want to lay all my stuff on her. And I worry about how she’ll respond to the news about Greg, that’s my ex.”

“Lots of people have been struggling with their aloneness during the pandemic, can you talk about what it’s like for you.”

“I’ve always hated being alone, ever since I was a little girl. I was the kid who was afraid of monsters under the bed, always had to have a light on, and would run into my parent’s room in the middle of the night. That’s why it took me so long to leave Greg, even though I knew about his affairs for years. And when he moved out I put way too much pressure on my daughter to be my companion, just as my Mom did to me. I mean, my parents stayed married, but they had a lousy relationship and I was my mother’s confidant. My Mom’s still alive. She remarried after my father died and she’s much happier now. We’re close, but not like it was when I was a kid.”

“Are you saying you miss your childhood relationship with your Mom or that you’re relieved?”

“I don’t know. Maybe both. When I’m happy, I’m relieved. But now that I’m so anxious, I guess I want my Mommy. I know that sounds silly.”

“Not at all. I totally understand.”

“I did tell my Mom about Greg, but she didn’t get it at all, thought I’d be happy that something really bad happened to him.”

“And is a part of you happy?”

“Oh no! I mean he certainly wasn’t a good husband but I could never be glad he got cancer.”

“So you’d feel guilty if you felt glad?”

“Definitely. I was brought up to be the good girl and the good girl I remain.”

“Can I ask you how this is feeling to you right now?”

“I guess it still feels weird. And I’m still anxious. I’m used to having my anxiety get better when I’m in

a therapist’s office. But I guess I’m not in your office. It’s like you’re here and not here. It’s similar to how I feel talking to my New York friends on the phone. They don’t feel really present to me so I’ve pretty much let most of those relationships kind of peter out.”

“Oh oh,” I say. “Does that mean you’re likely to do the same thing with us?”

She shrugs. “I don’t know.”

“Maybe you yearn for relationships that duplicate the early connection you felt with your mother, perhaps that’s the connection that reduces your anxiety, makes you feel safe, and that without that kind of connection you feel afraid.”

“I guess that’s true. But I thought I wanted to get away from my mother.”

“I suspect that a part of you does want to get away, but the scared little girl part of you still yearns for what you experience as safe.”

“I suppose.”

“I feel as though you’re less engaged with me right now.”

“Yeah. It’s not you. I just don’t know if this is going to work.”

“I suppose the question is whether you’re willing to give it a chance. We’ve actually talked about quite a bit today: anxiety, guilt, your need to be a good girl and, I suspect, although we haven’t talked about it, your difficulty allowing yourself to feel angry.”

Jennifer brightens. “That’s right! I feel really bad when I get angry.” Pause. “But right this minute I feel a little less anxious.”

“Maybe it helped that I figured something out about you, and that made you feel more connected, less alone.”

“Could be.”

“I can’t guarantee I’ll do that every session, but if you’re willing to give this a try, maybe our work together could be helpful, despite not being in person.”

In this month's blog, teletherapy diminishes the feeling of connection between patient and therapist restimulating old losses and increasing the dread of new ones.

Chelsea, a relatively new social worker, is talking about her work at the local hospital. “It’s scary being there right now, even though there isn’t all that much to do since our census is so low. Still, having to deal with families who are deciding where to place their elderly relatives is hard, even harder than usual. Who would want to put someone in a nursing home right now? But some families just can’t take them home – small kids, home schooling. It’s a challenge. And it’s worse since I have to do it all by phone or video conferencing.”

“Interesting, Chelsea, since that’s how we have to work too.” I have been seeing Chelsea for several years now, beginning when she was in college, through her Master’s program in Social Work and now as a beginning professional. We have a strong, caring bond. But switching to teletherapy has been difficult for us. Something is definitely missing. I even suggested we switch to FaceBook, hoping that might recapture our connection. But it’s still not the same.

She sighs. “Yeah. But the problem I have with the families isn’t the same as the one I’m having with you. I don’t know the families, so not seeing them in person makes it harder for me to have a sense of who they are as people. I mean if someone is sobbing about the thought of putting their mother in a nursing home, I certainly get how they feel. But if they’re more neutral, is it because they don’t care or because they’re just trying to hold it together. I can’t tell.”

“But that’s not true for us?”

“Not at all. I most definitely know who you are.” She smiles. “You’re my savior. I don’t know where I’d
be if it wasn’t for you. I mean I know I have a mother transference to you. How could I not, with my mother dead by the time I was nine and no one else really caring about me? But this not in person stuff just isn’t working for me. I even considered asking you if we could take a break from our sessions until we could meet in person again.”

“Really? I’m surprised.”

“Yeah, I know. But I chickened out. It would feel like too much of a loss.”

It would feel like a loss to me too, but I keep that feeling to myself.

“Maybe it would be helpful, Chelsea, if we really tried to figure out what the difference is for us, because I agree with you, something is different, something is missing.”

“I just don’t know,” she says shrugging. “I have wondered whether it’s somehow related to my mother’s death, but I’m not sure exactly how. Sort of like how she faded away from cancer and whether us not being in person makes me feel as though you’re fading away too.”

“That’s a really good thought.”

“But you know, just saying that made me really anxious. Like, my God, are you fading away? Are you leaving me? Are you dying? That’s so terrifying to me I can hardly stand to think of it. I mean, here we are in the middle of a pandemic and you have to be in the age group that’s most at risk. But I never thought of that. I never thought I might actually lose you!” Chelsea says bursting into tears.

“I understand that would be really scary. And sad. And of course I can’t tell you I won’t get Covid, although I’m trying my best not to.”

Still crying, Chelsea looks up at me, stricken, shaking her head. “So many thoughts just went through my head. I think I’ve been mad at you. I think I’ve been mad that you weren’t seeing me in person, like you were rejecting me. But that’s not true at all. You weren’t rejecting me, you were taking care of me, trying to stay here for me. I mean not just me, for yourself and for your other patients too. But I think I’ve been mad and scared and sad and I didn’t know about any of it! What’s wrong with me!?”

“Nothing’s wrong with you, Chelsea,” I say smiling. “This is a scary, unknowing time for us all, including not always knowing what’s going on inside of us. And death is all around us. It’s hard not to worry about loss, or to defend against acknowledging it.”

“I feel so incredibly sad. I truly don’t know how I’d deal with losing you.”

“I understand. And I hope you won’t have to deal with it for a very long time.”

“You know what, though? I feel closer to you right now.”

“I agree. Defending against fears of loss meant we lost each other in the present. And that’s even worse than losing each other in the future.”