Priorities and Connections: Observations From Social Work Private Practice in the Age of COVID-19
by Elisabeth Joy LaMotte, LICSW
While its reputation signals intensity and connection, therapy is a surprisingly socially distant experience. I typically shake hands with therapy clients before the beginning of the first session. Following that fleeting physical connection, we social workers in private practice remain bodily distant for the duration of a relationship that sometimes lasts for months or even years. My clients and I sit several feet apart, we begin with a sterile discussion of scheduling, and we end – sometimes abruptly -- as I explain that we are out of time. None of these awkward formalities apply to my other relationships. I’m a hugger who is slightly hard of hearing. In social settings, I tend to sit close, lean in, and would rarely tell a friend that I am out of time.
Rather than “socially distant,” I would describe psychotherapy as “physically distant and socially awkward.” Despite its structure (and in part because of its structure), therapy is also intimate and powerful. The formalities bookend an exchange that uses the structure as a jumping off point to delve deeply into an exploration of the human experience.
A couple of weeks ago, I hoped (foolishly, in retrospect) to continue to see clients in person at least until directed to shelter in place. But on March 17th, I learned that a psychologist practicing near my office in Washington, DC, had tested positive for the coronavirus after attending the annual conference for the American Group Psychotherapy Association in New York earlier in the month. She may have unknowingly infected others, including her children and her clients. I have attended this particular conference a dozen times, and have frequently presented. I thought about attending this year, and then decided otherwise.
I feel concerned for my therapy clients. The weeks ahead may be traumatizing. I briefly imagined my office as a place for clients to get out and do something safe and therapeutic to counter the isolating experience of being at home indefinitely during a global pandemic. But no amount of wiping down doorknobs with Lysol or staggering appointments that are typically back-to-back offers full protection from this virus. After learning about the therapist who tested positive, I headed home, emailed my clients, and switched over to my telehealth virtual office for the foreseeable future.
What struck me earlier in March was my clients’ common ability to discover subtle upsides during this dire moment in time. A young, ambitious attorney explained:
The past week was the first time I have slept well in months. The courts have slowed their schedule, and I finally feel like I can keep up. I’m way less stressed, even as I worry for my parents. We FaceTime every day, which is much more frequent than during real life.
A successful consultant in her thirties echoed similar sentiments:
I have been commuting for more than two hours a day for several years. How did I not realize how much it was wearing me down? I hope when this is over, corporations notice how many of us are actually more productive and healthier if we are trusted to have some built in freedom to work from home.
As the situation unfolds, clients express brutal ups and downs. People are coping in stages. Those who don’t feel busy enough struggle to structure their time. Many feel busier than ever, running governmental programs from home while balancing a toddler on their knee during back-to-back Zoom sessions. Mastering the mute microphone is key.
Relationship dynamics seem amplified, both in terms of their strengths and their limitations. Couples may experience more tension, but many report more sex and more togetherness. A client in his fifties who initiated therapy feeling estranged from his wife of 25 years described a pleasant shift:
We’re doing great so far. We’re creating a routine and re-discovering how well we work together in a crisis. As long as we don’t spiral at the same time, we are able to help each other through. I don’t think I need to meet virtually, but I will get back in touch if things spiral.
Concerns about burnout and work life balance are long-standing research topics, and multiple studies demonstrate that people who work longer hours are more depressed, experience greater anxiety, and are more likely to have sleep disturbance. The Harvard Business Review reported in April 2017 that “the psychological and physical problems of burned-out employees, which cost an estimated $125 billion to $190 billion a year in healthcare spending in the U.S., are just the most obvious impacts.” Social worker Brené Brown’s groundbreaking studies of human vulnerability demonstrate that humans are hardwired to form deep connections. When we are vulnerable, we feel more intimate and more connected, and anxiety lessens. As difficult as this current self-quarantine feels, it seems to be forcing an overdue re-alignment in priorities.
The coronavirus crisis is evolving by the minute. Current emotional gains may fade with time. Or they may amplify. This is World War Three, and we are all fighting a common enemy. The financial turmoil, physical danger, and emotional strain create adversity for all and tragedy for many. But for some, this crisis may become a painful but meaningful catalyst to re-prioritize and form deeper connections.
Elisabeth Joy LaMotte, LICSW, is a social worker in private practice and founder of the DC Counseling & Psychotherapy Center. Elisabeth's book, Overcoming Your Parents' Divorce, was a finalist in the 2008 National Best Book Awards in the relationship category.