A Therapist's Challenge During COVID-19

For the first time in 27 years as a couples therapist, I'm taking sides.

The deadly threat of COVID-19 has pushed me into the role of public health educator as couples differ over how to handle the pandemic. As states lift some restrictions, the conflicts within households have intensified.

Frequently, one partner takes warnings seriously - practicing social distancing, limiting grocery store runs and staying at least six feet from people when out on a walk. The other partner, however, ignores social distancing and gets defensive when their partner becomes angry or upset. The hypervigilant spouse is pushing their partner to do something they don't want to do - like wear a mask and avoid close contact with people.

Normally, I'd encourage a couple to talk together to foster understanding of the other's perspective. Not now. The public health imperative limits time to explore dynamics and discuss underlying feelings such as fear and love. If clients' coping systems put themselves, their family and the public in jeopardy, I feel a responsibility to say something.

As people want to join vigils and marches or tire of stay-at-home orders, couples clash as to what's more important - expressing their opposition to police brutality or listening to scientists and maintaining social distancing. I've encouraged clients expressing their solidarity with 'Black Lives Matter' to find other ways to act on their beliefs. If couples agree that joining a protest is worth risking their health, I urge mask-wearing and social distancing.

When couples disagree about household hygiene to ward off COVID-19, I've reinforced social distancing guidelines and angered clients. As a therapist, that's a compromising position for me to be in. Some people cope with difficulties and stress through avoidance and undue positivity.

One of the major divides I see in relationships is one person who worries too much and one who doesn't worry enough. One partner might worry about household finances or their children's screen-time while the other partner has a laissez faire approach. For many couples, this public health crisis has put these differences into stark relief.

At the risk of alienating clients and igniting their anger, I tell them the science and data are irrefutable. This pandemic isn't going away any time soon, even if we're tired of our freedom being curtailed. It's with fear and trepidation that I speak up. I understand that what I'm about to say brings potential consequences. My hope is that they'll change their behavior. They could leave therapy. I'm willing to take that risk.

It's not as if I'm grabbing clients by the collar; I understand that people don't like to have these facts brought to their attention. Their coping style is to avoid these issues. And so, I gently ask clients questions to help them get back to reality, such as, 'Do you believe this is a serious issue? If so, do your choices and behavior match the magnitude of the risk?' I challenge their reasoning.

It's what I'd do if a client mentioned drinking and driving but preferred to focus on his fear of his partner leaving him. Ethically, I need to focus on the bigger issue and help my client address the drinking and driving, before talking about his breakup fears. A few people who didn't appreciate my candor have taken time away from therapy. While it might cause a bump in the therapist-client relationship road, most people have been able to, with help, make a sharp U-turn and adjust their behavior.

The coronavirus holds the same threat to human life as driving drunk, on a larger scale. Some clients don't want to talk about COVID-19. They want to live their lives as usual. I get that this is hard. It's antithetical to our instincts. When we're anxious or concerned for loved ones, we want to reach out and be with them. Some young adults especially want to visit family or a significant other.

But young people are dying. Healthy people are dying. Essential workers, from those in health care to store clerks, are risking their lives for all of us. We cannot mess around with this. Prolonged social distancing has to win.

I tell my clients we're all in an ecosystem, and the actions of each individual impact the whole society. The activity of one member of the household can put the entire household at risk.

So, when one partner wants to follow the news and talk about coronavirus and their partner wants to get lost in a book or TV show, I'll help them navigate their different coping strategies. But when a partner approaches the lifting of restrictions as if it's business as usual, I shift out of neutral.

Cynthia Post, Ph.D., is a licensed psychologist in private practice in Silver Spring, Maryland, specializing in couples and family therapy. For the past 18 years, she has appeared on multiple FM stations discussing mental health issues as part of the Maryland Initiative to Increase Public Education.