Today, 10 months after we were notified that a novel coronavirus has arrived in the United States, I received my first dose of the Moderna vaccine. I was reluctant to get vaccinated because I have suffered from severe allergies for quite a number of years. It was determined that my allergies were multifactorial which progressed to the point where I was prescribed specialized medication to keep my symptoms under control. Needless to say, I was concerned about how the vaccine would react to my immune system and other medications I was taking.

I have been classified under the Phase 1A of the COVID vaccine protocol because I am a healthcare provider who will eventually get back to seeing my clients face-to-face in an office setting. A number of clients have asked me throughout the Pandemic if I would be returning to the office anytime soon. I have had to explain that I was not only following the state guidelines to minimize the length of indoor meetings, but I have also been talking to other colleagues about this, many whom were not ready to take that kind of risk for their clients and themselves. For many, including myself, offices remain vacant with no return date in sight. 

For various reasons, a number of clients have decided to drop out of treatment when I went to all virtual sessions. I heard from clients back in March of last year that they would come back into treatment after “all this was over.” Others have told me that they didn’t like the “feel” of the virtual sessions or didn’t understand the technology that would allow them to meet in this way. And many clients have told me that they did not have the privacy at home to be able to talk about their issues openly without the possibility of being overheard by a family member. Subsequently, I have met with clients in their cars, attics, basements, and on walks around their neighborhoods to try to find an area where they could talk without uninvited ears listening in on them. 

Periodically, I have returned to the office to pick up mail and to sit in an empty room thinking about the benefits that coming to a setting outside the home can bring. Sitting in the same room and sharing space with a client is, in my opinion, the best way to do the necessary work together. There is the three-dimensional experience where the client and therapist share the same space to form a connection that a two-dimensional computer screen cannot produce. When working with a client in the office, body language can be seen more readily which can often indicate to the therapist that the client may be feeling a certain way that may benefit from exploration. And “gut” reactions can be felt which may indicate that something has been triggered in either the client or therapist. On a computer screen many of these nuances occurring in the session may be missed; however, it should be noted that we are lucky to have a virtual mode of communication to use as a tool to let the therapy treatment continue.

The value of a client coming to the office is part of the clinical process that can tell much about their commitment to therapy before they arrive. The client needs to keep his or her appointment after it was set. A cancellation of the first session usually does not bode well for the therapy process. A client should be prompt with their first appointment as well as subsequent appointments. A client should know that the therapeutic hour is theirs alone and it should proceed without any interruptions, for example, without a cell phone sounding phone or text alerts. And the client should understand that their privacy and confidentiality is protected in the office setting so full disclosure of material can be discussed.  

During the course of the Pandemic, I have worked with others in ways like never before. Adolescents going to “school” through virtual classes, adult clients who have lost their jobs due to COVID and are trying to “reinvent” themselves, a seemingly increase in marital discord (it’s hard to tell if marital and relationship issues have increased because couples, especially married people, tend to wait an inordinate amount of time to seek help for their problems), family problems, an increase in substance use, and the complexities that come with losing a loved one.  Many of these issues have been challenges before, but they have been exasperated by the coronavirus.

Attending school from home, although it is a viable way for students of all levels to continue their education and obtain assignments, has reportedly caused eye strain, stiff neck and shoulder muscles, and an overall feeling of boredom from sitting in front of a computer screen for hours at a time. Students have reported getting easily distracted around the home that can jeopardize the retention of material that was presented by a virtual instructor.

A number of clients have been trying to figure out their next move regarding employment after they have been laid off, furloughed, let go from their lucrative jobs, or lost businesses outright. People in the transportation industry, the performing arts, restauranteurs, caterers, hospitality and gaming, and small businesses of every kind are struggling to get back to work or are looking to find an alternative career, but are unsure on how to get started. Some people are looking to go back to school to get or complete their degrees, but are deterred due to the time and cost it will take to obtain it.

Marital issues and family problems seem to be on the rise due to the inordinate time people have been quarantined together without much let up. People are working from home and going to school from home thus eliminating any separation between home life and work life or a regular school day oftentimes with after school activities. It’s much more difficult to get a measured work/life balance when the home has been relegated to living, working, and schooling under one roof. 

Families are bickering amongst each other, couples not communicating effectively, and socialization with schoolmates and friends has practically ground to a halt. Prior to COVID, people world go about their normal day and come home to talk about what had transpired during their time away. COVID has kept people from going out of the home for any length of time thus perpetuating seclusion, isolation, and quarantine with the same people every day.

Since COVID has taken a front seat to most other problems, substance use disorder has skyrocketed without many people noticing. Alcohol and drug use is on the rise with drug overdoses having taken over 80,000 lives over the last twelve months. In many instances, treatment beds for addiction such as detox and rehab have been replaced with COVID patients. So not only have the resources for addiction been minimized, but substances use has increased. Unfortunately, this trend is likely to continue as people struggle to cope with all the loss that is attributed to the virus.

COVID has even changed how we deal with the illness or loss of a loved one. In many cases, people are not allowed to visit a family member or friend while they are in the hospital for fear that someone from the outside will bring the virus in with them and infect staff or patients. Virtual meetings are sometimes arranged if the patient is not too ill to participate. People who can visit their loved ones in long term care facilities, have to talk through a glass door or window and must leave without giving a simple hug. And when someone dies, funerals are reserved for just a few immediate family members who may or may not get to see their loved one final time. As of this writing, over 400,000 American citizens have died from the virus and unfortunately that number is likely to climb. 

I began this article by stating that I had recently received my first COVID-19 vaccine. I know that even after the second shot I will still be wearing a mask, social distancing, and avoiding seeing people indoors until the state decides when it will be safe to lessen restrictions. Much to our dismay, the Pandemic may go on for quite some time. And although many of us have long tired of the isolation, quarantine, a reduction of “normal” activities and limited time with extended family and friends, we will need to see this through in order to protect the lives of ourselves and others. What the new normal will look like is anyone’s guess. But suffice it to say, COVID will more than likely have lasting changes into the future. 

Robert C. Ciampi, LCSW is a psychotherapist in northern New Jersey and author of the book, When to Call a Therapist.