Coronavirus Disease 2019
Should Therapists Go Back to the Office?
Part 1: COVID-19 has reminded us what therapy is really about.
Posted September 29, 2021 Reviewed by Lybi Ma
“I made it!” I think, panting. “I’ve beaten my client to our session!” My Manhattan psychotherapy office is a stage set—large, well-lit, and aesthetically coherent—and I loathe getting caught “backstage.” I hang up my tailored coat, inhale, and decide that I have indeed made it. It’s January 2020.
Two months later, I’m floundering through a teletherapy session with my client Don, in the basement of my Brooklyn home. I’ve had to move locations “mid-scene,” as our main quarters have become dominated by my husband’s board meeting and our 2-year-old, raging against his nap. I’m wearing sweatpants, a button-down shirt, and a king’s robe—a Halloween costume I found on the floor and wrapped around my shoulders to keep warm. “I’m so sorry,” I say, cringing in defeated mortification. “It’s really cold down here.” We both laugh. And as we do, a shared sense of exuberance enters the scene. Don continues, seeming more self-reflective and participatory than usual. For years, he’d been reserved and highly curated. As the session ends, he thanks me for being “genuine” at this “challenging time for all of us.”
I shut my laptop, feeling particularly connected to Don, to my work, and to myself. Then I walk upstairs to free my son from the nap that’s not happening, leaving my costume behind.
Seeing clients through the COVID-19 crisis has shown us not only that psychotherapy can be effective outside the traditional frame—complete with an office, couch, and a therapist who never breaks character—but also that shattering the frame when necessary, and allowing our humble humanness to be present, is actually necessary to connect with each unique client.
Well over a year into teletherapy, whenever I’m asked when I’ll “go back” to an office, I wonder what “going back” would mean. Hurrying and running from my clients? Trying (and failing) to hide beneath a costume? Denying them, and myself, my best clinical resource: My true self?
My work with Don is a clear example of the contrast between my pre-pandemic approach, and what both my clients and I are capable of now. The work Don and I did over the years was certainly meaningful, but our pre-pandemic scenes were sometimes akin to what legendary director Peter Brook calls the deadly theater: commercial theater produced solely to satisfy the expectations of the masses. We sat in the right chairs and spoke our lines like obedient actors. Don chose his words cautiously as if he might flub a line, haltingly telling me: “I’m getting better with boundaries.” And I’d reply, “I appreciate your efforts.”
One day, pre-pandemic, while Don was mid-sentence, my phone buzzed. It was my son’s daycare—I had to take the call. But I was consumed with guilt for disturbing Don.
“Is everything okay?” he asked, sounding genuinely concerned.
“Yes,” I lied. “Please continue, you were saying—”
I said the right line. But my eyes screamed: I broke character! Pretend this didn’t happen! And those cues aren’t exactly an invitation for someone to open up about themselves.
Part of me knew better: I’m a trained actor who teaches workshops for therapists on how to use oneself authentically to connect with our scene partners. I’m acutely aware of how subtle facial expressions and tones of voice reveal emotional reactions. And yet, with Don I was too self-conscious to be fully present with him—and, of course, one must be present to play, as the great psychotherapist Winnicott recommended we do with every client. Instead, I tried to deliver what I thought Don wanted: A therapist who acted like a therapist. And that meant there was a conspicuous lack of freedom and vitality between us.
Therapists create deadly therapy, much more than we realize. Upon reflection, I can now see I exacerbated Don’s own fear of getting caught “backstage,” by trying to disavow what I had plainly revealed to him with my face and body language: that the call had made me feel worried and guilty (the daycare had told me my son had a fever, but unfortunately I wasn’t able to pick him up right away). Like screen actors, we reveal volumes of subtext with our eyes to our scene partners and audiences, reflexively and at the speed of light. By attempting to mask my reality for Don in some kind of clinical neutrality, I implicitly sent him the message that he too should simply ignore his present reality whenever it comes into conflict with social and professional expectations.
Then COVID stole the show. And the abrupt dismantling of our set and change of costumes awakened us to ourselves, and to our relationship with one another. Though we were now separated by screens, we were no longer divided by the performative expectations that had kept us at an emotional distance.
As we carried on each week, I was amazed to discover that when my son interrupted our scenes, Don would share more rather than less. He’d light up and tell me about his dreams of having kids, and his own mortifying tales of video meetings gone wrong.
I no longer tried to hide backstage—I couldn’t really anymore, what with my son screaming in protest when he was denied a second episode of Elmo, or a bowl of strawberries, or the entire outside world. I stayed present in the spotlight and, like a committed improv partner, I responded with Yes rather than No.
“I guess you’re not the only one who’s had enough of this quarantine,” I’d say, as I allowed my face to respond with genuine embarrassment, frustration, and contrition, inviting Don to join me in speaking freely.
Don and many other clients have since consistently reflected on their thinking, feelings, and choices with more risk-taking vulnerability, brave self-awareness, and openness to change than I had witnessed before COVID. I can’t imagine any therapist wanting more for their clients.
Read More in Part 2
This post also appeared in Psychotherapy Networker.
Copyright Mark O'Connell, LCSW-R
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