Beyond the Mask: Tales from the Pandemic
Originally written as a contribution for a series of short stories discussing Covid-19 and its impact on the world at large. For many, Covid-19 entered the world’s stage and turned everything upside down.
During a global pandemic, when therapists are looking after their clients, who is looking after the therapist? Samantha Heuwagen discusses how she navigates the uncertain time between the first wave of the pandemic and finding a new normal––in and out of the therapy room.
There is No Roadmap: An Essay about Resilience, Vulnerability, and Being Enough Though the Eyes of a Therapist (Written in May 2020)
The tink tink of my nails against my coffee mug echoed through my snug office. The tea sent a reassuring wave of strength down my spine, a strength I knew I didn’t really feel. The world around me was plummeting into chaos, and part of my job was to help make sense of it with my clients. After all, I pledged my life and career to helping others through therapy. I should know how to help stop the panic or at the very least, offer coping strategies to help alleviate it.
Shouldn’t I?
I spent four long years of grad school: two in a master’s program to help me see the world clearly with its unfair advantages and crumbling social safety nets, and two to learn how to be a therapist. I was trained for a time like this. I was innately ready to face a plague that would now make itself known in every facet of our lives, forever changing the foundation we foolishly thought would never buckle under pressure.
Aren’t I prepared for this?
I knew in the very fiber of my being that my training would be useful. It would help me and my clients walk through to the other side of this, even if we didn’t know what would await us once we got there. I could trust in my ability to reach out and help smooth the rough edges of life for my clients. I knew that self-care, a good diet, sleep, and connection with others could pull us through the crisis of COVID-19.
The hard part would be convincing my clients that staying focused on health and what they could control really would help them.
With new regulations making it harder than ever to see loved ones, it would fall on me to help my clients come up with alternatives to stay sane and present through whatever came next during the pandemic. That was my job, the very thing I vowed to do with my career.
Yet all of it felt meaningless and utterly useless.
There isn’t a roadmap for any of this, I thought bitterly. I wish I could see my therapist. I sighed, forcing my depressive thoughts and dimmed hope for humanity back to the present, back to the stillness of my office and the mug of tea in my hands.
As a therapist, it’s paramount we work with our own personal therapist to help us process our own stuff. But in this time of crisis, my own therapist had closed her doors. Taking two weeks off to… Well, I wasn’t sure why. She didn’t say. My guess was to prepare for a future none of us could outsmart. Was she storing food? Toilet paper? Taking trainings? Setting up her practice to do telemental health?
I didn’t have it in me to ask or press her on it. I only hoped she would be back soon to help me process what was going on around us. I needed the space to work through layers of tangled emotions. And if I couldn’t get these emotions in check, how would I be able to hold space for others?
I put my cup down on the table next to me and stood, my back cracking from sitting too long in one position. As I looked around my office, dread filled me.
If I couldn’t keep it together to get through this next session, I would be letting myself down, not to mention my clients. I strongly believe that in order to provide effective therapy, I need to be present and in the right mindset to help fully. I shuddered, already stressed from this new “normal.”
On my lunch break, I’d gone to the store to try to find cleaning supplies to keep my office sparkling clean and safe. Both stores I checked were out of everything, along with the strange mix of anxiety and desperation floating off the other shoppers. That force nearly caused me to go into a downward spiral. My panic was bubbling up again, ready to spill over. I’d been lucky enough to keep it at bay at the store, but now, in my office, my feelings were ready to make themselves known.
Inhale, long exhale. Inhale, exhale… Willing my mind to focus on my breathing, I kept the tidal wave of emotion from cascading over. For now.
Unlike most therapists, I wasn’t going one hundred percent online. It’d never been my favorite mode of therapy, so I’d reserved it for emergencies prior to COVID-19. Now, it was a financial lifeline, to say nothing of a health and safety one. Once I committed to switching over, some clients outright refused. They said they didn’t have a safe space to talk, or that they didn’t feel comfortable talking about what we do with the chance someone could be listening. Even more just wanted to be out of the house and feel a connection to another person––to simply sit with someone else in a safe space.
I could offer a safe space in my office, but I couldn’t guarantee that elsewhere. Though HIPAA laws had been toned down to allow doctors and other healthcare providers like myself offer more opportunities to meet virtually, I understood my clients’ concerns. The stigma of mental health and therapy was still far too great.
I had to make a choice. I could stop therapy altogether with those clients for an unknown length of time and not make a dime, or I could continue to see them and clean to the best of my ability between sessions.
The choice was difficult but obvious.
In order for my practice to survive, I would have to continue to see clients online and in person.
I checked the clock. Fifteen minutes before my scheduled in-person session with Eliza*(name and identity changed).
Eliza and I had been working together for a little more than six months on various topics surrounding anxiety. A few days prior, I’d received an emergent call from her. Her anxiety was taking over and making it hard to focus on anything other than COVID-19.
”I can’t stand this,” she’d said, her voice filled with unease. “I have no idea what I’m supposed to be doing and where I’m supposed to go. Should I stay at my apartment or head home with my parents?”
”That’s a great question,” I told her. “Where do you feel safest right now? What would help you navigate this situation the best?”
The silence on the other side of the phone lingered. “I don’t know… Everything is so confusing. They’re closing schools, and I think my job might even require me to work from home!”
”I know, I know,” I said, not sure if I was reassuring her or myself. My worries for the next few weeks threatened to flare up. “It’s hard. No one knows what the next step should be, but listen, where do you think you’ll feel safest?”
She hesitated, fumbling with the phone. “I think I would feel better with my parents. Does that make me weak?”
I smiled even though she wouldn’t be able to see it. “Not at all. Asking for help makes you the strongest person I know. I think that if you feel safe with your parents, you should stay with them until you’re ready to go back to your apartment or until things die down. Feeling safe is the most important thing right now.”
”Okay, I agree.” Her voice lightened, but there was still some reservation.
”What’s going on in your body? Do you still feel out of control?” I asked.
”I feel better knowing I have a plan. My body feels tired, but my heart is calming down.”
”Great! What can you do right now to help gather yourself? What self-care is available to you?”
Self-care is taking time for you, giving back and appreciating the moment. It allows for some peace and allows you to refuel in order to give to others. Everyone’s self-care looks different. We pull upon things in the moment, like a cup of tea or controlled breathing, working our way up to other things like reading or relaxing in a bath. Even going outside and walking around are self-care. Acts like emotionally connecting with someone else, or even sex, can also be ways of releasing stress and refocusing on the present.
I knew we’d constructed a helpful list for her to call upon when she needed. I was hoping she had the time and space to give back to herself until she felt more confident and in control.
”Talking to you has helped.” She sniffed. From the sound of her voice, I could tell she was relaxing, but the physical effects of her anxiety were still present.
“Awesome, I’m glad! What else?”
She sniffed again. “I’m definitely going to do yoga after this, then pack to head over to my parents.”
”Don’t forget to pack all the fun things you may need,” I reminded her, “like any of your books or electronics. Could you imagine no phone charger?”
We laughed.
The memory reminded me of an intervention I wanted to try with her. Some coloring––a free draw of whatever came to her mind to help her to relax into her subconscious while we spoke. The intervention would help her focus on something other than her words––an exploration of her emotional state. We could turn on and off different parts of herself to dig into what was causing her anxiety.
Walking over to where I kept my supplies, my own personal reservations about COVID-19 began to simmer to life.
I didn’t have a clue what would happen next, not that any of us did. What we would discover about this virus? Its impact on the very fabric of our lives was turning people away from each other, that much was clear. Those ramifications would be the ultimate destruction if we didn’t find ways to reconnect. We needed each other, and I dreaded that the fear beginning to show itself across the country would create an even larger divide in our culture. There was a growing chance we wouldn’t be able to recover from.
I shivered. I had no control over the future, as much as I wanted to pretend I did.
The grief of losing our normal was palpable. The loss was making itself known by the hoarding shown on the news and the long lines at grocery stores. Through the back and forth on social media posts on what to do next. The cancelations of much awaited events. It was clear across the world and our own communities, we were hurting.
Whatever would come our way, I still believed we had enough resilience to overcome, even if the world outside had forgotten.
But from appearances, it looked like were turning away from embracing vulnerability. In the book Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead by Dr. Brené Brown, vulnerability is defined as “uncertainty, risk and emotional exposure.” Where love, joy, connections, courage, empathy, and creativity thrive and are welcomed into our lives. It is the opposite of weak, as so many believe, but the strength that brings us closer to others and helps showcase who we are authentically (Brown 2013).
I refused to turn away from vulnerability. In my bones, I knew I needed to embrace it. We all did.
Since the pandemic had started, I’d been determined to take my clients on the path of promised connection, empathy, and healing. I asked them about their connections, about their families and friends. I asked them how there were going to stay in touch with loved ones and what they were doing to feel whole. Many said they were grateful for technology and being with their families. Some were going as far as to schedule days dedicated to each friend group or work colleague. They were as dedicated as I was to staying connected, showing love in our own ways using the tools we had at our disposal.
Some were not so lucky, though.
Some of my clients felt utterly alone, too afraid to reach out for fear of being seen as weak or that they would bother others. Their limited social circles were closing in on them, making it hard to see the light of day. In those cases, I was the closest thing they had to connection with the outside world. My heart broke for them, but my constant presence in their lives never wavered. Where was their safety net? Though the lockdowns were imperative to stop the spread of the virus and keep everyone safe, it cut many off from other humans––that fact perhaps more dangerous than the virus itself.
Suicide rates climbed, talk of ending life soared, and what could clinicians do? With ERs packed with COVID-19 patients, hospitals were left with no other choice but to turn them away. We were facing a pandemic with few resources to spare.
The pressure of my job sat heavy on my shoulders. The weight of each decision, each session, filled me with more questions than answers.
There is no roadmap for any of this, I reminded myself. My mind felt slow, burdened with too many what ifs and not enough insight to help my clients navigate these strange new times, to say nothing of how to manage my own growing dread.
Because none of us, myself included, know how to navigate this new “normal.” It innately creates trauma, a quick study of how to get through this crisis. Watching so many people parish while a government struggles to provide a sense of safety impacts our sense of self and wellbeing, causing our brains to constantly ask if we’re safe. The problem is that there is no answer to that question because the virus is still so unknown.
My dream was to be the best therapist I could, using all the best practices I’d learned along my career. Now, facing something I felt ill-equipped to handle, the pressure to deliver “good” therapy created this incessant loop of self-doubt and second guessing. I felt like I wasn’t enough.
There is no roadmap, that small inner voice kept reminding me. Its reassuring presence was a warm hug that radiated deep into my bones.
Years of education, practice, and trainings had led me to this moment and even though it didn’t feel like enough, it had to be. I had to be enough because me being me—flaws, anxiety, and all—was enough. I had the strength and the resilience to get through anything life threw at me, even a pandemic virus. Even if I doubted every step, I needed to push forward.
A dim hope formed in my heart.
Maybe, just maybe, it was okay not to know what to do. Everything would work out because at the end of the day, showing up would be enough.
By openly talking about what’s going on around us and not pushing big emotions aside, mine included, my clients and I would begin to heal together. Embracing flexibility in scheduling and how we met would create a feeling of control and safety. My clients knew I’d be there for them to the best of my ability. My understanding that some may not even want to talk about the world and continue to focus on what brought them to therapy in the first place was also crucial to helping them feel secure. Showing up ready and prepared for my clients in whatever way they needed would be putting my best foot forward and offering them some relief during these uncertain times.
My phone dinged, and a message from Eliza streamed across the screen. It read, “I’m here and ready to come in!”
If my clients were willing to put in the work to overcome, I sure as hell could do the same for them. They were the bright light in my life and inspired me to be the best version of me. I wouldn’t let them down.
Tucking my worries away, I wrote back, inviting her in.
In times of crisis, no one knows what they’re doing, and that’s okay. It makes us more connected and splendidly human. COVID-19 came and kicked our butts, but it didn’t win. Life goes on, and it just changes, like we do.
