In March 2020, at the start of the COVID-19 pandemic, I wrote a blog for the Networker in which I made a seemingly innocuous prediction. “No matter how accustomed I become to working remotely,” I wrote, “I know I’ll gladly get back in my car and return to my office when this is over. What’s more of a question is, will my clients feel the same?”
What a difference a year can make. Upon reflection, I’m embarrassed by the naivety of the assertion above. How could I have thought that anyone could live through a pandemic and not be changed by it? At the time that I wrote that essay, telehealth was new to me and so many other therapists, and I was frantically trying to get up to speed on Zoom and other platforms. More than a year later, I’ve changed, my clients have changed, and the world has changed.
As we know all too well, the pandemic led to transformations large and small for everyone. Some people lost their jobs, others tragically lost their lives. Schools were closed and travel came to a screeching halt. The messaging about what was safe and how long lockdowns would last was inconsistent, even frightening at times. There were more questions than answers. But now with emergency measures lifted and most adults vaccinated, I’m contemplating what returning to my office will actually feel like. The pandemic changed not only the locale of where I practice, but it also changed how I practice.
The impact of COVID has led me to examine many assumptions I’d held about what was essential to my work life. As a psychologist with a solo private practice, my office was a critical component of where and how I did my work for over thirty years. Unlike many of my colleagues, I never wanted to have a home office. After a year of working remotely, I have a new appreciation for the benefits of telehealth for both me and my clients. My clients are adults, and I know that for therapists who work with families or young children, the challenges of both telehealth and returning to in-person sessions are even more complicated. But for me, the more important question now is not whether or not I will return to my office, but rather how remote work has changed me as a therapist.
One of the most profound changes brought about by telehealth was a softening of boundaries between me and my clients. Switching to Telehealth brought us into each other’s homes. My window into their lives expanded, as did theirs into mine. At the beginning of the pandemic, I gave clients my cell phone number and email address, since I wouldn’t be in the office checking my landline frequently. Even though none of my clients misused these new ways of contacting me, I can’t now ask them to unknow this information when I do return to my office, but maybe I can give up the expense of having a landline.
Clients also showed a newfound interest in my well-being; frequently asking me how I was doing. Back at the start of the pandemic, one client, the wife of a trauma surgeon, was frantic with worry following her husband’s descriptions of the nightmare emerging at his hospital. She was afraid that I would get COVID and die. Every session, she asked me to reassure her that I was safe.
Other clients began our sessions with uncharacteristically casual conversation, I suspect as a byproduct of our more relaxed settings. It also took effort for people to distinguish therapy sessions from all the other remote meetings and conversations they were having. I came to accept interruptions from pets and people in our sessions that I would never have tolerated in my office.
As a result of these changes in the rhythm of my sessions, I wonder if, at least in the beginning, being back in my office might feel more formal, and ironically, more distant. Rather than being a few inches apart on a screen, we will be at least six feet apart in our designated seats. One of the aspects I have missed the most in my work is literally welcoming people into my office. Those first moments where I observe the physicality of the person tell me so much about their well-being, something that telehealth could never replicate. But sitting in my waiting room is far more formal than sitting in bed with your cat on your lap and being invited into a session from a remote waiting room. Going back to in-person sessions will probably retain some of the informality attained from remote work as we acknowledge this increased awareness of each other’s lives.
The push to be back in my office full-time isn’t without some pull to stay remote, both from me as well as from some clients. After an early adjustment period, increased time with families was an unexpected gift for many people during the pandemic. Most of my clients embraced this change, as did I. After nearly forty years of marriage, my husband and I have never had this much time together (he’s also working remotely). Instead of routinely being apart for 12 hours a day, we now see each other for brief moments throughout the day and sometimes have lunch together. At the end of the day, we close our computers, throw on our sneakers, and head out for a walk. We made a vow at the start of the pandemic that we would take a walk every day, no matter the weather. Our little adventures took us to new neighborhoods and expanded our connection to our community. Instead of pulling into the driveway at the end of the day and rushing to make dinner, we now digest our day one step at a time as we slow down and try to grasp how the world has changed. As much as we miss the rich life we had going to concerts and theater, these walks have brought us closer in new ways. We changed our routines and forged some new ones. While I once took long hours at the office and being stuck in traffic in stride, I don’t want to return to that schedule at this stage in my career. Working some days from home doing telehealth will be critical to my happiness and well-being in the future.
Just as I’m not sure I want to be bound by the location of my office, it’s also no longer convenient for several clients who won’t be returning to theirs. Negotiating with them about whether sessions will be in person is new ground to cover in treatment. Moving forward, I can imagine that decisions about where sessions take place will be just as important as discussions about missed sessions, and be fodder for examining deeper aspects of the therapy relationship. For example, eight months into the pandemic, I requested that all my phone therapy clients have one video session. I made this request because I felt the need to see whether the self-report of their well-being matched my visual assessment. While many clients chose to talk by phone so they could be out on private walks or because they found it less distracting, others were clearly hiding. One client agreed to the video session but used a false backdrop so I could see him but not the mess in his apartment. He has a tendency to hoard, and the behavior was exacerbated by the pandemic. Although he might prefer to stay remote, I’m inclined to insist he come to the office at least periodically for sessions. Individualizing treatment protocols will inevitably include discussions about how and where the treatment is delivered.
The prospect of going back to my office full-time feels much more complicated than it did when I locked the door over a year ago. It’s quite literally become a very expensive post office box where I occasionally go to collect my mail. I still love it: the comfort of my leather chair and ottoman, the warmth of the paint color, and most of all, the now-rare privacy I have when I’m there. I also miss the colleagues that I’d normally see in the hallway of my office building, and meeting them for coffee or lunch. But, at some point if my work is predominately on remote platforms, the expense of maintaining a physical office may no longer be fiscally prudent, which could result in me offering only telehealth sessions.
My commitment to keeping my clients and myself safe continues to be a guiding force for me as I decide where I do my work. I plan to return to my office in September for both in-person and telehealth sessions. I have yet to work out the specific details of how I’ll change my schedule so I can have fewer days at the office. Once I know how many clients want in-person over telehealth sessions, I hope to build a schedule that keeps some of the flexibility I’ve come to appreciate this past year. Adopting a hybrid work model is the new normal for most professions, and undoubtedly therapy will be part of that change, assuming insurance companies continue to reimburse for telehealth sessions.
My greatest fear of adopting a hybrid model is that it makes it very difficult to truly be off from work. Between there being nowhere else to be during the pandemic and the dramatic increase in people’s mental health needs, it was easy for me to say yes to work for the past year. There were no snow days or holiday plans to limit my work life. Given how blended my home and work life became between using my cell phone for client calls and my email for scheduling sessions, I lost the separation I covet between my personal and professional lives. Typically when I take vacation time, I travel and welcome the chance to disconnect from work. Compounding the issue, my caseload rarely ebbed and flowed the way it did pre-pandemic, as clients chose to have their sessions no matter where they were located. As travel restrictions ease and planning vacations becomes possible again, I’m confronting reestablishing boundaries with clients about my availability, as I desire the chance to pull back my accessibility. Whereas prior to the pandemic my vacations (as well as those my clients’) provided acceptable breaks in treatment, it somehow feels more harsh and abrupt now to be truly unavailable. It remains to be seen how well boundaries can be renegotiated and reinstated.
All of us, therapists and clients alike, have been forced to adapt to the reality of living in a pandemic. But as we catch our collective breath, we must confront the fact that the pandemic opened a Pandora’s box of questioning what once seemed non-negotiable. We’ve been individually and collectively changed by this experience. I can now say with humility that I am less sure what therapy will look like in a post-pandemic world, as both we and our clients adapt to establishing a new normal.
Photo © iStock/Chansom Pantip
Maggie Mulqueen, PhD, is in private practice in Brookline, MA. She’s the author of On Our Own Terms: Redefining Competence and Feminity.