This article is from the source 'nytimes' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.

You can find the current article at its original source at https://www.nytimes.com/2020/05/03/nyregion/coronavirus-therapy-nyc.html

The article has changed 31 times. There is an RSS feed of changes available.

Version 25 Version 26
Therapists and Patients Find Common Ground: Virus-Fueled Anxiety Therapists and Patients Find Common Ground: Virus-Fueled Anxiety
(7 days later)
On a good day, New York City is awash in its neuroses, a tightly wound place where a wide assortment of sky-scraping anxieties can build to an almost comic crescendo.On a good day, New York City is awash in its neuroses, a tightly wound place where a wide assortment of sky-scraping anxieties can build to an almost comic crescendo.
But with the coronavirus pandemic grinding on, that angst has reached new heights. Many New Yorkers are cloistered in their homes, often jammed tight with family or roommates; others must report to work in a contaminated city. They are dealing with isolation and fear; some have lost their jobs. Others are sick or in grief.But with the coronavirus pandemic grinding on, that angst has reached new heights. Many New Yorkers are cloistered in their homes, often jammed tight with family or roommates; others must report to work in a contaminated city. They are dealing with isolation and fear; some have lost their jobs. Others are sick or in grief.
It can be overwhelming, even for the mental health professionals tasked with easing such problems.It can be overwhelming, even for the mental health professionals tasked with easing such problems.
“Never have I ever gone through a trauma at the same time as my clients,” said Melissa Nesle, a psychotherapist in the Chelsea neighborhood of Manhattan. “All I am hearing all day, hour after hour, is what I am experiencing also.”“Never have I ever gone through a trauma at the same time as my clients,” said Melissa Nesle, a psychotherapist in the Chelsea neighborhood of Manhattan. “All I am hearing all day, hour after hour, is what I am experiencing also.”
At points, Ms. Nesle added, the situation has made patients reluctant to unburden themselves. “They are aware to some extent that I am sitting in a New York City apartment, too,” she said. “So I will say to them, ‘Yes this is really stressful; I feel you; I hear it.’ But I want to reassure them that I am OK.”At points, Ms. Nesle added, the situation has made patients reluctant to unburden themselves. “They are aware to some extent that I am sitting in a New York City apartment, too,” she said. “So I will say to them, ‘Yes this is really stressful; I feel you; I hear it.’ But I want to reassure them that I am OK.”
She added, “I am not always.”She added, “I am not always.”
Facing the deluge of patient need, the city’s health professionals have scrambled to adapt. Emergency legislation enacted by Congress in early March has expanded some psychologists’ ability to provide telehealth treatment to adhere to social-distancing requirements. Some hold remote sessions in parked cars and even closets to maintain client confidentiality from their own sequestered household.Facing the deluge of patient need, the city’s health professionals have scrambled to adapt. Emergency legislation enacted by Congress in early March has expanded some psychologists’ ability to provide telehealth treatment to adhere to social-distancing requirements. Some hold remote sessions in parked cars and even closets to maintain client confidentiality from their own sequestered household.
Others have found themselves in stunning conjunctions with their patients, like one therapist who spent the first several weeks of the outbreak in sessions, managing the grief of others, only to have her own 87-year-old father die of the virus earlier last month.Others have found themselves in stunning conjunctions with their patients, like one therapist who spent the first several weeks of the outbreak in sessions, managing the grief of others, only to have her own 87-year-old father die of the virus earlier last month.
From the city’s many therapist-client relationships — now taking place on Zoom and FaceTime sessions — a new concern has emerged: mitigating the emotional toll on mental health professionals, who must confront virus-oriented anxiety at work and in their personal lives.From the city’s many therapist-client relationships — now taking place on Zoom and FaceTime sessions — a new concern has emerged: mitigating the emotional toll on mental health professionals, who must confront virus-oriented anxiety at work and in their personal lives.
After a grueling two weeks of powering through remote therapy sessions, Dr. Lucy Hutner, a psychiatrist who specializes in women’s mental health, said the cumulative effect of absorbing the same worries compelled her to collapse into bed at 7 p.m. recently, and pull the covers over her head.After a grueling two weeks of powering through remote therapy sessions, Dr. Lucy Hutner, a psychiatrist who specializes in women’s mental health, said the cumulative effect of absorbing the same worries compelled her to collapse into bed at 7 p.m. recently, and pull the covers over her head.
Under normal circumstances, she said she would tap into her own emotional base to “analyze the emotional experience of what may be happening with the other person.”Under normal circumstances, she said she would tap into her own emotional base to “analyze the emotional experience of what may be happening with the other person.”
“I am so used to feeling angry or sad or a moment of joy for my patients, and this was a completely different experience,” Dr. Hutner said. “I realized what it was: It was just all of the fear and the panic and the trauma and the stress that I had been absorbing from every side.”“I am so used to feeling angry or sad or a moment of joy for my patients, and this was a completely different experience,” Dr. Hutner said. “I realized what it was: It was just all of the fear and the panic and the trauma and the stress that I had been absorbing from every side.”
At Mosaic Mental Health in the Bronx, therapists have been challenged to maintain continuity of care: Few patients have computers, and many cannot afford even to top up credits on their cellphones to reach their therapist, said Donna Demetri Friedman, the executive director.At Mosaic Mental Health in the Bronx, therapists have been challenged to maintain continuity of care: Few patients have computers, and many cannot afford even to top up credits on their cellphones to reach their therapist, said Donna Demetri Friedman, the executive director.
Their clients are among those hardest-hit by the virus: Black people and Latinos account for 62 percent of the city’s virus-related deaths, even though they make up 51 percent of the city’s population, according to data from the city’s health department.Their clients are among those hardest-hit by the virus: Black people and Latinos account for 62 percent of the city’s virus-related deaths, even though they make up 51 percent of the city’s population, according to data from the city’s health department.
Since the lockdown began, the center has stretched far beyond just emotional help: Its staff now delivers not only prescriptions but meals to patients.Since the lockdown began, the center has stretched far beyond just emotional help: Its staff now delivers not only prescriptions but meals to patients.
“I do a lot of self-care so that I don’t take on the intensity of what we see day to day,” Dr. Friedman said. “But with this, it’s so pervasive, there’s so much death, there is so much uncertainty, the helplessness can creep in, in ways that it typically doesn’t.”“I do a lot of self-care so that I don’t take on the intensity of what we see day to day,” Dr. Friedman said. “But with this, it’s so pervasive, there’s so much death, there is so much uncertainty, the helplessness can creep in, in ways that it typically doesn’t.”
“We are doing everything and anything to help each other and our patients to get through this,” she added. “Sometimes, that’s crying together.”“We are doing everything and anything to help each other and our patients to get through this,” she added. “Sometimes, that’s crying together.”
Many New York City therapists are turning to existing and newly created peer assistance networks. Last month, the American Psychoanalytic Association started a peer-advisory program for navigating the coronavirus; on its first day, over 1,000 members applied for just 245 openings, said Todd Essig, a chair of the association’s new Covid-19 advisory team.Many New York City therapists are turning to existing and newly created peer assistance networks. Last month, the American Psychoanalytic Association started a peer-advisory program for navigating the coronavirus; on its first day, over 1,000 members applied for just 245 openings, said Todd Essig, a chair of the association’s new Covid-19 advisory team.
In January, the China American Psychoanalytic Alliance, which trains Chinese mental health providers, began coaching therapists in Wuhan and other parts of China on how to provide telemedicine. Those Chinese therapists have returned the favor, teaching their counterparts in the United States best practices learned through their ordeal, said Dr. Elise Snyder, the founder and president of the alliance.In January, the China American Psychoanalytic Alliance, which trains Chinese mental health providers, began coaching therapists in Wuhan and other parts of China on how to provide telemedicine. Those Chinese therapists have returned the favor, teaching their counterparts in the United States best practices learned through their ordeal, said Dr. Elise Snyder, the founder and president of the alliance.
Some therapists have enlisted therapists of their own. Others have taken up meditation, or build their days around walks.Some therapists have enlisted therapists of their own. Others have taken up meditation, or build their days around walks.
Dr. Elena Lister, a psychiatrist on the Upper East Side who specializes in loss and grief, spaces out her sessions to include time to do breathing exercises between each one. In Chelsea, Ms. Nesle heads to her roof between appointments.Dr. Elena Lister, a psychiatrist on the Upper East Side who specializes in loss and grief, spaces out her sessions to include time to do breathing exercises between each one. In Chelsea, Ms. Nesle heads to her roof between appointments.
Others find refuge in routine. Every morning, Richard Angle, a clinical psychologist, drives from his home in Brooklyn through the nearly empty streets to his office on the Upper West Side — even though he is exclusively holding phone and teletherapy sessions.Others find refuge in routine. Every morning, Richard Angle, a clinical psychologist, drives from his home in Brooklyn through the nearly empty streets to his office on the Upper West Side — even though he is exclusively holding phone and teletherapy sessions.
Updated August 6, 2020 Updated August 12, 2020
“I’m a little nerdy. I still wear my suit,” Dr. Angle said. “Maybe this is silly on my part. For patients who may see me, it’s keeping some sense of a frame or normalcy.”“I’m a little nerdy. I still wear my suit,” Dr. Angle said. “Maybe this is silly on my part. For patients who may see me, it’s keeping some sense of a frame or normalcy.”
Not everyone seeking therapy has the same concerns, even if the coronavirus is the cause behind them.Not everyone seeking therapy has the same concerns, even if the coronavirus is the cause behind them.
The city’s clergy are also facing a deluge of people desperate for counsel, and many have found themselves overwhelmed.The city’s clergy are also facing a deluge of people desperate for counsel, and many have found themselves overwhelmed.
“What if they hate God and have a crisis of faith, who do they tell that to?” said Dr. Michelle Friedman, a psychiatrist on the Upper West Side who specializes in pastoral counseling. Via the Jewish Theological Seminary, Dr. Friedman has been holding pastoral counseling sessions for clergy of all faiths. “So I am going to try to help them identify what their resilience is.”“What if they hate God and have a crisis of faith, who do they tell that to?” said Dr. Michelle Friedman, a psychiatrist on the Upper West Side who specializes in pastoral counseling. Via the Jewish Theological Seminary, Dr. Friedman has been holding pastoral counseling sessions for clergy of all faiths. “So I am going to try to help them identify what their resilience is.”
But Dr. Friedman also has a swath of more affluent patients, some of whom call in from their country houses and are comparatively shielded from the crisis.But Dr. Friedman also has a swath of more affluent patients, some of whom call in from their country houses and are comparatively shielded from the crisis.
“Whatever anxieties or issues are being activated — a person upset that he hadn’t gotten into his pool yet, or somebody worried about losing their job — I have to not judge,” she said.“Whatever anxieties or issues are being activated — a person upset that he hadn’t gotten into his pool yet, or somebody worried about losing their job — I have to not judge,” she said.
Fear and uncertainty has pushed many already fragile patients into profound mental health crisis, several therapists said. Some said they had to have patients hospitalized for their safety, a measure that carries a new layer of guilt for the risk of exposing them to the virus in a hospital.Fear and uncertainty has pushed many already fragile patients into profound mental health crisis, several therapists said. Some said they had to have patients hospitalized for their safety, a measure that carries a new layer of guilt for the risk of exposing them to the virus in a hospital.
But there are bright moments: One relationship therapist said that couples sequestered together in close quarters have been forced to confront their issues and do deeper therapeutic work.But there are bright moments: One relationship therapist said that couples sequestered together in close quarters have been forced to confront their issues and do deeper therapeutic work.
Dr. Hutner, the women’s mental health specialist, says it is her patients who have persevered in the past through debilitating mental illness that have helped her through.Dr. Hutner, the women’s mental health specialist, says it is her patients who have persevered in the past through debilitating mental illness that have helped her through.
“They’ve already had an experience of their world getting turned upside down, just this time it’s external, and usually it’s internal,” Dr. Hutner said. “It has given me a perspective of understanding that people can get through a lot more than they think they can, and that includes myself.”“They’ve already had an experience of their world getting turned upside down, just this time it’s external, and usually it’s internal,” Dr. Hutner said. “It has given me a perspective of understanding that people can get through a lot more than they think they can, and that includes myself.”
For some analysts, never revealing the self is a professional credo, even now. Mark Borg, a clinical psychoanalyst in Manhattan, adheres to that dictum, so he did not tell his patients that while he kept up video sessions, he had the coronavirus himself.For some analysts, never revealing the self is a professional credo, even now. Mark Borg, a clinical psychoanalyst in Manhattan, adheres to that dictum, so he did not tell his patients that while he kept up video sessions, he had the coronavirus himself.
But as he worsened, his patients caught on, and suddenly the roles of doctor and patient were reversed: “They started picking up on a cough here and missing attention there, and my patients started, in a funny, kind of embarrassing way, I have to admit, becoming caretakers of me,” said Dr. Borg, who has since recovered.But as he worsened, his patients caught on, and suddenly the roles of doctor and patient were reversed: “They started picking up on a cough here and missing attention there, and my patients started, in a funny, kind of embarrassing way, I have to admit, becoming caretakers of me,” said Dr. Borg, who has since recovered.
“They so desperately wanted, needed me to be OK,” Dr. Borg added. “So that I could be the caretaker that I have been for them.”“They so desperately wanted, needed me to be OK,” Dr. Borg added. “So that I could be the caretaker that I have been for them.”