Is it time to stop talking about COVID?
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Early in the pandemic, as the world adapted to a rapidly changing viral landscape, I co-chaired the American Psychoanalytic Association’s COVID-19 Advisory Committee. We closely followed the advice of the CDC and top medical experts; we also reviewed and conducted surveys related to COVID-related concerns among our members. We have produced relevant newsletters, blogs, videos and podcasts on adjustments to mobile therapy online in this time of COVID. Keeping up with these changes was practically a full-time job.
This shift in focus has resulted in a major adjustment for most clinicians: move our practices online. At first, only 20% of our field had substantial experience with online therapy. The global change was both immediate and massive; it required multiple educational efforts, counseling, and a whole support network to help people get up to speed. As time passed, bigger questions arose: do we stay this way forever? Are we abandoning our offices for good? The sometimes steep learning curve led to the development of a literature on best practices in online psychotherapy and psychoanalysis, as well as differentiation as to when it was necessary to see clients in person.
It wasn’t just practicing psychotherapists who had to make accommodations, of course. Teachers from all walks of life, from kindergarten to graduate school, found themselves faced with having to acquire a completely new set of skills: online teaching. (The International Institute for Psychotherapy, of which I am a founding member, offered to help develop particular expertise in this area since we had been doing online education for over 20 years.) These resources have become useful to people as they transition, settle into a new way of teaching, learning and conducting therapy.
And then, seemingly overnight, the world opened up again. COVID is still with us, but it’s no longer new; it has become part of our way of life. COVID risk continues to be factored into our behavior, of course, but instead of threatening noise, it’s now more like white noise: constant, pervasive, and largely benign.
Go to the next phase
One thing we know for sure: COVID will never really be “over”.
Epidemiologists tell us it is heading for an endemic phase; concretely, this means a long-term adjustment. Most of us have decided whether or not to return to the office, adjusting to patients who prefer to meet online (and others who insist on returning to meeting in person). As mandates become mere recommendations and political tensions ease, some feel caught in the middle. What happens next?
Many of us balance the demand for online sessions with what often feels like screen fatigue. We struggle to know how over-safe the security is, even though prolonged social isolation is known to be detrimental to our mental health. Many younger colleagues, still in their prime, are finding that their need for office space has diminished, while in-person networking and training events become common again. Still others of us just worry…worry too much.
A fractured political landscape, new findings about the virus and growing demand for a return to normality have made “what to do” increasingly unclear. One certainty is this: we all now have to adapt to a new way of thinking about COVID in our lives.
Find the “right” level of risk
Given the mixed regulatory signals, the generally declining but still oscillating number of infections, and our own rapidly changing personal circumstances, it is now more difficult than ever to decide our tolerance for risk. Unless we stay socially distant forever, we have to accept risk while witnessing events that will sometimes lead to spread. If the effects of the “long COVID” are still unknowable, we also know the psychological risks of remaining too cloistered.
While no one has all the answers, it can be helpful to keep the following points in mind when choosing a course of action:
1. We all face the risk of contracting COVID.
With any social interaction – big or small, indoors or outdoors, 100% vaccinated or not 100% – we have to accept some level of exposure. We are all going to have to calculate from event to event and day to day how much risk we are willing to accept.
2. Adapting to increased risk is nothing new.
We are entering a period of transition in human history, but it is certainly not the first time. Just as the world was shaken and then forced to adapt to the tragedy of 9/11, we will have to adapt to the reality of COVID. The same adjustment happened after the Cold War and, almost 100 years ago, after the 1918 pandemic. And now we also carry the sense of risk to the world that emanates from the war in Ukraine! The risk of COVID may be somewhat permanent, but our heightened fear about it is most likely temporary.
3. Risk budgeting is an ever-evolving personal choice.
Our tolerance for risk can increase or decrease depending on our immune system, our jobs or the needs of our families. How each of us will live with the knowledge of continued endemic risk has yet to be determined, but clearly we must continue to be mindful of our ongoing calculations.
This month, our COVID-19 Advisory Committee has decided to end its activities. COVID itself hasn’t ‘lapsed’, of course – it just became part of the atmosphere – but offering guidance and support for the choices we now face is work best best attributed. conversations with friends and trusted advisors. Our final advice could apply to COVID risk as easily as any other element of psychological health: be aware of your emotional needs; communicate your needs and limitations; and be patient with those who have different perspectives on risk.