Counseling in the Time of Coronavirus By Roberta Satow, PhD on 3/12/20 - 11:46 AM

On January 11, China announced its first death from the Coronavirus. On January 13, the WHO reported a case in Thailand, the first outside of China, and Japan's health ministry reported a confirmed case. The WHO said later on January 23 that the outbreak did not yet constitute a public emergency of international concern and there was no evidence of the virus spreading outside of China.

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I was concerned enough to bring face masks and antiseptic wipes in case people were coughing on the plane, but on January 24, my husband and I boarded a plane to Sydney, Australia. A couple of people were wearing masks on the flight, but not many. I didn’t put on a surgical mask, but I wiped my food tray and arm rests with the antiseptic wipes. While we were in Australia and New Zealand, we kept hearing that the virus was spreading.

When we returned from Sydney on February 26, the Japan Airlines lounge was not serving food; the staff in the lounge walked around spraying disinfectant; and the flight attendants all wore face masks. More than half the people on the flight were wearing masks as well. My anxiety about the virus increased exponentially.

On my first day back to my office, my first patient, Rosalind, asked me about my vacation and then turned to her anxiety about the Coronavirus. She said she had ordered a carton of Lysol and Clorox wipes; she took her shoes off and washed her hands upon entering her house. Her son had a doctor’s appointment at a hospital and she wasn’t sure if she should cancel it. She asked if I was scared because I’d just been on a plane returning from vacation. Since she has an anxiety disorder, I thought it was important to help her separate out her internal reality from the external reality, but it was not easy.

“I understand why you are concerned. There is a danger of the Coronavirus spreading and it makes sense to wash your hands frequently and use Clorox wipes. But I think it’s important to try to separate the reality of the virus and your internal anxiety.”

“Yes, that’s exactly what I need to do.”

“While it’s important,” I continued, “to wash your hands and use antiseptic wipes and try to avoid crowds, it is also true that most people who get the Coronavirus don’t die from it. Elderly people with underlying medical issues are the most vulnerable.”

“Yes, people with respiratory problems. Yes, I’m not elderly and in perfect health. Yes, that helps.” She took a deep breath.

After that session, I felt conflicted. On the one hand, I didn’t want to frighten my patients or subject them to my anxiety. But, on the other hand, I needed to protect myself as well as my patients. I walked around the office with a can of Lysol and sprayed all the door handles. But I needed to model a way of coping with a frightening reality that neither denied it nor exaggerated it. I decided to put Clorox wipes in the waiting room with a note saying: “Please wash your hands or use one of these before coming into the office.”

When Rosalind returned the next day, she remarked on the Clorox wipes and said it made her feel safer. She thanked me for doing it. I felt good about it; I felt I’d found the right balance between keeping the office safe and without unduly frightening my patients.

But then Florence came to her first appointment. She told me that while I was on vacation she had found out she had cancer! I was stunned. But she seemed calm about it so I strained to keep calm. She told me the story about what had led up to the diagnosis and then turned to another subject.

“I visited my mother in her nursing home over the weekend and it was fine. Everything seemed normal. My son Ronnie went on Sunday and spent 45 minutes there. It’s a good thing we went because on Monday morning, they started a ‘no visitors’ policy.” She laughed.

I felt a rush of anxiety. She visited a nursing home? I was frightened for her because she is in a compromised state, and also because she could now be spreading the virus!

I didn’t question her decision to visit her mother, and I didn’t point out that she put herself in a vulnerable position. But I felt anxiety running through me — for her, her son, and for me. As soon as she left, I walked around the office spraying Lysol on all the door handles.

So what is my conclusion? I do not have any answers, because dealing with the Coronavirus is a work in progress. We have to feel our way. I think I have to keep walking the fine line between keeping my office safe for my patients and myself and not letting my anxiety get the best of me. But as it spreads, patients may not want to use public transportation or they may get quarantined. I will offer phone sessions if either of those things happen. At times like these, it’s good to talk to our colleagues and commiserate about how to handle this crisis and others like it that we may encounter. 

File under: The Art of Psychotherapy, A Day in the Life of a Therapist, COVID-19 Blogs