Almost 1 year into the pandemic, the day finally came when I could welcome patients back to meet in person. For a little over a decade, I have cared solely for the mental health of healthcare professionals. After nearly a year of telehealth, one by one I welcomed nurses, physicians, physical therapists, nurse practitioners, pharmacists, social workers, resident physicians, and physician assistants into my office space.
At that point in the pandemic, there was no denying that exhaustion had set in.
My flock was weary and worn out from the constant vigilance required to live and work within the COVID environment. Each time I walked to the waiting room to collect a patient, I was met with comments focused on my waiting room couch. "Can I just stay here?" "This couch is so comfortable." "Can we meet here, I don't want to get up?" A woman who I have seen for years asked for my permission to resume her position on my waiting room couch after our session: "Can I just sit here?"
At that time, I distinctly remember feeling that if I picked someone up a few minutes early from the waiting room or even within a minute of them walking in with no time to sit down, I was robbing them of something.
Fast-forward one year to the present day. I decide to present a new patient to my peer supervision group. Psychologists are required by their state licensing boards to establish a peer group with whom they can confidentially and safely discuss their clinical work. These groups serve several functions. They can help to deepen one's clinical thinking, ensure the provision of sound ethical and quality care, and help to reveal blind spots. My group is composed of two psychologists and three psychiatrists.
Before COVID, we shared our most vulnerable and intimate moments in our work with each other around our dining room tables. When it became clear that COVID was disrupting our work and home lives, the woman who initially brought us together did not hesitate to create an online link and invited each of us to attend at our regular time.
I chose not to attend.
Within 15 minutes, I received a text from her: "Where are you?"
I texted back, "I don't think I can do it tonight. I think I will just cry the whole time."
"We are all crying."
I logged in.
Suffering in Silence
On this recent occasion, I share with the group that I have been meeting with a mental health provider, and after four sessions, we have gotten off to a rocky start.
In addition to working diligently to care for his patients, he had also been caring for his partner who, with no mental health history, had rather quickly decompensated from mental illness 4 years ago. In our initial phone call, he explained that he had met with another therapist for a few sessions and was told that he seemed fine.
"I don't feel fine. I feel exhausted," he said.
During our initial visit, he described a history of significant losses. His dear friend had died of cancer in his early 40s and another beloved friend died suddenly of a heart attack, both following the premature deaths of several family members. He talked about scaling back his practice to be available to his partner. He talked about feeling consumed by her; no matter what he was doing a part of him was always with her, concerned about whether she would also die.
I listened closely, aware of the importance of bearing witness to his pain.
Over the years of caring for caregivers, they have taught me about the difficulties surrounding asking for help. As mental health providers, we receive additional training in self-awareness; however, we are not immune to the caregiver culture of "suffering in silence."
I share with my group how during each session, despite my attempts to explore his pain, I am rebuffed.
"He just keeps telling me how exhausted he feels," I say, mildly frustrated.
"He told me he can't afford to 'feel'. And then followed this with a story about a recent time when he allowed himself to relax only to find out that his wife was admitting herself to the hospital. I offered an interpretation about the sensed dangers if he were to relax and let his guard down."
"No, that's not it," he said.
My group is silent. They continue in their steadfast listening.
"At the end of that session, I found myself reminding him of our agreement to check in after a few initial visits so we could talk about how things are going between us."
During the next visit, he says, "I just don't know how to put what I'm feeling into words. I'm not even sure that would be helpful. Honestly, when I walk into your office, I see your couch and all I can think about is how nice it would be to lay down on your couch and sleep."
I am flabbergasted.
Toward my group I become more animated, "He listens to people talk about their feelings for a living! He doesn't see the point in talking?"
A voice emerges from my group.
"Chase, he IS telling you what he needs."
I am at a total a loss and look bewildered.
"He needs to be held. You are the couch 'holding him'."
Another voice pipes in, "And we will hold you, Chase."
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Cite this: M. Chase Levesque. When Words Are Not Enough - Medscape - May 16, 2022.