Starting Therapy Remotely

“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.”  

Loss: Past, Present or Future?

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.”