Finding the Perch: Psychotherapy During Mutual Uncertainty and Grief By Susan Hurwit, PsyD on 6/2/20 - 3:07 PM

As we know, the creation of a ritualized space between two human beings is often a challenging and intimate endeavor. As an experienced child and adult psychologist, I have learned how to sit with people through excruciating times of suffering, fear, longing and grief. Whether it involves hearing about a difficult relationship or about an acute or chronic trauma, my most important task is to try to feel or imagine what a patient feels or felt at a particular time.

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This will involve an understanding of the patient’s psychological strengths and weaknesses, their biology and temperament, their inner conflicts and how they came to be the person they are. Just as important, it is about feeling their disappointments and their delights. My hope is that the patient will be able to discover and embrace something yet unknown. Perhaps there will be a glimmer of freedom or authenticity, or maybe of something frightening or deeply buried. It will be raw, fresh and unmetabolized at first. What is crucial is that this process begins with my commitment to trying to feel what the patient feels.

The nuances of what heals varies tremendously. Maybe it is significant that I am bearing witness to something being remembered or processed, or maybe I offer a different perspective or silent wisdom. However, it is essential that I can also step outside the patient’s feelings to be able to help spark something new. I am not completely in the telling nor in the immediate experience with them. For example, if a patient is talking about a painful experience of being shamed as a child, I am right there, feeling the shame inside myself as I imagine what they may have felt. But I also keep a tiny piece of myself outside the experience to guide the process of meaning-making or to watch it unfold. This is the crack, the perch, where I can live.

But now during the pandemic, it is harder to find that opening. Practicing psychotherapy as of March 2020 has necessitated that I pay attention with a new kind of vigilance. You see, sometimes there is not a time lag between what my patient brings and my own feelings. We may be breathing in the same grief. I am now experiencing fear and uncertainty at the exact moment in history as my patients are. Yes, we both arrive with different vulnerabilities and histories, (although probably with a similar longing for a pretend mother to help us make sense of it all), but the overwhelming shattering of life as we knew it is happening at the same time.

In our meetings, I often hear my own concerns expressed through the filter of who my patients are. “Why is no one taking care of our country or planet?” “Where is a Goddess or an omnipotent ruler to lead us forward?” “Who will rescue us and what do we do with our longings to be loved so we can strengthen our humanity?” “Will I watch my children die?” Sometimes I am suddenly aware that I am sitting with someone who might be articulating my pain in words that I have not yet found.

The pandemic has equalized our “playing field” or our perceptions of the field we share. We are now all “in this together.” A patient may feel permission to step outside themselves and ask, “How are you, and your ‘loved ones’?” The patient’s need to check in with me and ask how I am feeling is much more natural now, and when I answer, I don’t want to be dismissive of their interest in me nor disingenuous with a quick response. As of March 2020, we are more intimate. I will end up saying something like, “I am as well as can be during these difficult times,” or “So much is swirling inside me, I am not sure how to put it into words yet,” or “Thank you for your care. I am sad and scared but finding ways to keep myself buoyant and in the present moment.”

How can I continue to hold myself outside of what we are experiencing to be of best service to my patient? Where can I perch and settle, if only for a moment? How will this mutual uncertainty, while often unspoken, affect our ongoing relationship? These are the questions that my colleagues and I ponder, even in our dreams. Despite my own fear, I know that my experience and kindness will prevail. I am certain that my commitment and love for this work will continue. I just hope that soon the perch will be easier to find.

File under: The Art of Psychotherapy, Musings and Reflections, COVID-19 Blogs