A therapist’s tales from lockdown

Until early March 2020 I had the privilege of working as a psychotherapist in a sequestered consulting room in Marylebone where interruptions were taboo. Now, I am working on Zoom from my office in the matrix of our multi-generational house where nobody can escape sounds of the doorbell ringing and dogs barking.

Zoom sessions are neither better nor worse but different. Importantly, the technique has ‘democratised’ therapy. While I continue to hold the bounda-ries and ethics of therapy now it is the patient who chooses where their Zoom session will happen. Covid-19 has forced me to build new models of resilience whether dealing with clinical or domestic frustrations and to keep everything that frustrates, with the exception of human suffering, in proportion.

I have found myself being received on Zoom in bedrooms, a bathroom, sheds, garages and have even received a tour of a private art collection. I have learned not to feel slighted when someone says, “Hang on a tick that’s the doorbell.” It requires spoonfuls of tact on occasions when it is my clinical responsibility to question the roots, or patterns of unconscious behaviour and challenge concealed meanings or questionable actions. When tech-nology goes wrong, I must never blame the patient’s device, only remind myself how different it would be if the pandemic had preceded the internet. Everyone is more sensitive to hints of implied criticism. We are living in territories of existential dread and the unknown, and it is now at the therapist’s peril if they do not tread softly.

Covid news travels quickly and anxious patients text me more than pre-pandemic. Sometimes, I feel like the wedding guest in the Ancient Mariner who has no alternative but to listen. Listening may seem passive but good listening is always active and compassionate. I have learnt that it is harder to sit opposite someone on the screen and endure their tears without offering a Kleenex, or the extra-curricular hug. Announcing the end of a session sometimes makes me feel like an executioner. With individuals who are socially isolating, I may be the only person they speak to that day or even week, which is a responsibility harder to shut out with the remains of the day. It is at the end of the session when someone is likely to break down without the possibility of a tender intimacy at the door, a gestured sense of an ending.