Finding the Balance
How to Meet Stress with Tenderness during COVID-19
On April 21st, we were spaced out in our neighbor’s backyard as it grew dark. Each of us was carefully masked and gloved, each of us held a candle, couples and families dotted across the lawn. Then Jane came out on the balcony of her house in her mask and bathrobe.
The night before, she’d lost her husband, Charles, to COVID-19.
She spoke through her mask, thanking us for being there and telling us how much she and Charles loved being part of our little neighborhood.
“We love you. We miss Charles. We’ll be there for you,” folks called out.
Then, after a moment of silence, Jane went back into her house. Kate and I blew out our candles, waved to our neighbors, and walked back toward our home.
I took Kate’s hand as we headed down the hill and said, “I wish there’d been some response like this for my guy.”
“Who?” she asked, clearly preoccupied with her own sadness.
“My client John. But he was so isolated, and his family obviously couldn’t travel from New Jersey. I doubt anyone was there. I haven’t heard anything about a service yet either. He must have felt so alone. It makes me so sad.”
Kate put her arm around my shoulder as my tears came.
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The COVID-19 pandemic has touched all of us, whether we’ve lost clients, friends, neighbors, family, or we’re just living in fear and uncertainty, waiting for the other shoe to drop. These are truly dreadful times. And we therapists are supposed to be healers in the midst of it—this pandemic, this perfect storm.
The original perfect storm, which did great damage in New England in 1991, was created by three different storm systems colliding together off the coast. With this pandemic, we actually have four different storms colliding: the invisible assault of the virus itself, the enormous economic harm it’s doing to so many of us, the disproportionate impact it’s having on people of color (hopefully the country is finally starting to confront the institutional and systemic racism that pervades our nation), and the societal confusion exacerbated by our leadership about safety and reopenings.
How is this pandemic affecting us and our clinical work? Obviously, there’s no one-size-fits-all answer, but I thought I’d share some of the impact on me in the hope that it might be supportive as you cope with the impact on you.
In my work with clients, oddly enough, the shift over to remote work hasn’t felt that remote. It’s actually possible to feel connected and close while being on screen. However, I do miss the in-the-room experience of therapy. In a subtle way, I feel I’m less attuned to the nuances of people’s feelings via video. And like many of my colleagues, I’m experiencing much more fatigue in front of the screen than I would seeing clients in my office. Most of this fatigue comes from the emotional overwhelm of what we’re all going through. Some of it, however, is the cognitive dissonance of trying to have all these painful and powerful conversations remotely. Sending safe sanitized hugs through the internet isn’t the same, and it can feel lonely talking to a screen.
We also need to understand that for many couples and families, and frankly for me too, all the intense fear, sadness, and agitation is frequently coming out sideways. Is it really the case that a disagreement about whose job it was to clean up the kitchen is the cause for rage and threats of divorce? We’re faced with an invisible enemy, one that we can’t really fight or flee. Is it any wonder that this energy can explode in a moment’s notice with our beloved spouse or child?
One mom who’s been teaching her two boys at home sent me this joke off the internet. “Home schooling is going okay, except two kids have been suspended for fighting and the teacher has been fired for drinking on the job.” The humor had captured perfectly her feelings of overwhelm, frustration, and claustrophobia from 24/7 at home with her kids and husband. Her closing comment, however, was “Where did the funny go?” followed by a tearful emoji.
As a result of all this stress, a lot of people are unable to be their best selves consistently. I help them recalibrate their expectations of what they can accomplish in therapy in the midst of this pandemic. Just getting by without making things worse is a worthy goal. And digging into difficult relational issues might not be such a bright idea at this time.
Here are some of the interventions I’m using that are working the best for my clients, many of whom are also therapists (and for my wife and me, too).
Taking turns. In times of relational stress or external crisis, both partners sharing their upset often leads to emotional overload. More than ever, it’s important for couples to learn how to take turns expressing their feelings about this crisis so that one person can be attending to the other emotionally: in other words, taking turns having two of you paying attention to one of you at a time. When it looked like I was dying of stage 4 cancer, Kate and I alternated mornings having a turn, each of us feeling heard and held by the other as we discussed our particular fears and vulnerabilities.
Adjusting expectations. A lot of my work with couples is based on homework and what I call effortful love. With the intense stress of COVID-19 and homeschooling, however, many of them are having difficulty following through with homework. So I need to accept that couples might have a more limited bandwidth, and I need to help them accept that their annoyance and frustration with each other is likely amplified.
Distressed couples easily slip into old dysfunctional patterns, so some of the communication exercises I typically use to allow people to safely criticize each other aren’t working well because the listener can’t contain their reactivity. Even the turn-taking exercise above may not be a strong enough container to handle clients’ agitation with each other. So I’m encouraging couples to save their relational difficulties for our sessions and do positive behavioral interventions that don’t depend on feeling close or okay. Those are working much better right now.
The car ride home. I often teach clinicians to think carefully about the things said during sessions that could explode on couples in their car ride home. We therapists are often better at opening things up than closing them back over, especially since many feelings and issues are often brought up in the office that are not safe to say at home. Nowadays, clients end sessions in their living room, without any transition time, so it’s essential to consider closing sessions well and blocking “door knob” comments.
I discuss ending sessions on a positive note with my clients. In fact, I provide flexible scheduling, so if the session feels complete after 30 minutes, we can stop and they don’t pay for the whole hour. It helps with timing a more upbeat ending.
A daily centering practice. It’s important to schedule healthy self-care several times a day, as if your life depends on it. It does. As one of my friends says, “I’m meditating like my hair’s on fire.” Try releasing some of your toxic bodily energy with the well-known progressive muscle relaxation. I give clients online resources for this, and encourage them to do meditation, exercise, yoga, journaling. Poetry reading, listening to music, and therapeutic baking work well too.
Learning to be afraid well. I invite my clients to learn how to be skillfully fearful, rather than simply being assaulted by their fears. Most people try to manage their anxieties by stuffing them away and trying to ignore them. That won’t work; their fears will keep intruding upon them throughout the day. Instead, help them set aside some time each day to turn toward their fear. Name all their fears, write them down, acknowledge their feelings with self-compassion and tenderness.
I encourage them to make room for their children’s fears. With a pandemic, there’s no real reassurance, but you can model for them that it’s possible to be strong and steady and afraid at the same time. It will be a gift to them.
I invite my clients to learn how to be ‘‘skillfully fearful,’’ rather than simply being assaulted by their fears.
Chosen silence is better than frozen silence. When my family was going through my chemo, we’d designate whole days and even a weekend or two in which talking about cancer was off limits, even though we all knew we were thinking about it. It helped to team up on not dwelling on it. Similarly, although the stress of the pandemic may be on our clients’ minds all the time, it’s useful to help couples negotiate times when talking about it is off limits for discussion.
There may be times one member of a couple might want to talk about their fears and feelings while the other really can’t handle it in that moment. It’s important for partners to be able to say no kindly but directly when they aren’t able to be emotionally responsive to each other, and to schedule a time for later.
I also encourage clients to try to ration their exposure to the news. We keep looking toward information to help us get a grip on this overwhelming crisis, but constantly checking the news is likely to be overstimulating and anxiety provoking.
Practice tender loving care. More than ever, our clients need special attention and nurturing. I try to help people take turns receiving small, tender gestures of love and support, like a giving back rub, cooking a favorite meal, doing a partner’s chore, giving one partner time to sleep in and not get up with the kids. This works best when they each ask for one clear doable behavioral gesture each week, schedule it, and do it, even if they’re not in the mood. It’s a reminder that they’re there for each other and have each other’s backs.
Reclaiming our natural nurturing selves. At times of extreme stress, we may forget that often what nurtures us the most can be caring for others. We’re professional caregivers. Sometimes our professional role drains our love, caring, generosity, and nurturing nature. Sometimes we don’t have much left over for our children and our spouses and our friends. Sadly, our clients are often getting our best selves, and those closest to us are getting the leftovers.
During this terrible time, we can lose sight of the joy and sense of well-being that comes from volunteering our care. Consider the folks you know that may need a hand: cook for the sick neighbor, check in on friends who are alone, shop for people. Of course we’re too busy. Of course we’re exhausted and deserve a break. But trying this may actually make you feel better.
Grieving together heals. Zoom or FaceTime calls with family and friends and colleagues isn’t the same as being together, but it’s vastly better than holing up alone. Reach out, connect, but don’t just talk about how hard everything is. Play games like charades, be silly, tell jokes, share memories and stories, do karaoke, hold virtual sanitized hands, and for just a moment, reclaim your lives with others.
“Be kind, for everyone you meet is fighting a great battle.” This quote sits framed on my desk. It reminds me to open my heart to all people, including those with whom I have considerable differences. Each of us is scared in some way. Each of us is feeling threatened. Yes, we all have different coping styles, which causes conflict, judgment, and blame. But as MLK said, “Hate cannot drive out hate; only love can do that.”
Every morning Kate and I choose to send loving-kindness prayers to someone; often a family member or a friend who’s struggling. This morning, we chose humanity.
May all of us vulnerable, scared human beings be safe and protected.
May we all see ourselves and each other with love and compassion.
May we unite as a species to confront our common foe.
Right now, I’m writing this while sitting on my back porch on a warm, sunny spring afternoon. My porch overlooks a huge golden meadow, leading down to the woods, a river, and then rolling hills and nearby mountains. I am unquestionably privileged. There’s no other place I’d rather be to ride out this pandemic. I am so grateful and so sad.
“I’m going to be okay, Doc,” my client John wrote to me as he canceled our session before he headed into the hospital. And I believed him. Somehow, because he was much younger, I assumed he’d make it. Fifteen days later, he died—one of so many and all alone. I wish I’d made the extra effort to call him or send him flowers or a note.
Life as we know it has irrevocably changed. My son’s wedding this summer will be canceled. I have no idea when I’ll hold my grandson in my arms again. My wife and daughter- in-law are both physicians at risk. Some people I know and love may not make it. None of us are safe. As I said, we lost our neighbor.
I’m an old guy. I turn 75 this year. I’ve lived a blessed life alongside my beloved wife of 53 years. I’ve had cancer, heart disease, and a stroke. If it’s my time, so be it. But I’m aware that the amount of ice cream, cookies, and wine I consume is slightly increasing these days. And so have out-of-the-blue bursts of temper.
I’ve not simply been compartmentalizing; I’m actually pretty dissociated, falling back on my old childhood trick of disappearing right before my family’s eyes. Back when I was expected to die of cancer, I had a similar calm demeanor, which drove my wife crazy because I was so clearly not present. We called it my faux equanimity.
Fortunately, most of the time I do feel present with my clients. But sometimes I don’t, which feels really bad. I don’t know if that comes through on the screen; I hope not. Truth is, sometimes I’m practicing the old AA phrase: “Fake it till you make it.”
Luckily, I’m in touch with my feelings about others. My heart aches for our neighbor, and Kate and her fears about going into the hospital, and my sons and their wives. And particularly my grandson, Jacob. He’s a three-year-old delight. When we FaceTime, our main adventure is going into the garage to look at our cars, but first we have to search for the garage itself.
“Is it here, Jacob?” I ask as I focus the camera on the doorknob to the basement. “Shall I try it?”
I open the door, but it’s not the garage. Then we open the door to the refrigerator. No garage in there. It’s not in the microwave. Can’t find it in the dryer, either. As I keep asking my absurd questions, he delightedly laughs and says,” Nooo, the garage isn’t in there!”
Finally, we focus on one more door knob.
“Is this it, Jacob?”
“Yes, Pa Pa.”
“Are you sure, sweetie?”
“Yes. Yes. Open it!”
And I whip the door open, and there’s the garage with our two cars. He’s as delighted as I am. We found the garage.
What world will he find when he grows up, I wonder.
ILLUSTRATION © ILLUSTRATION SOURCE/TODD DAVIDSON
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