Originally appeared on Medium
In March 2020, when Covid-19 sent New Yorkers like myself into lockdown, the structure I had set up for my work as a therapist vanished. Sessions went virtual as I transitioned my practice onto digital platforms like Zoom and Skype. I was now in people’s homes and they were in mine. My cloistered consulting room had been replaced by bedrooms, bathrooms, parked cars…wherever there was privacy. Cats, spouses, and children were often unannounced guests on both ends of the line. Physical boundaries blurred along with emotional ones as my patients and I laid bare our feelings of shock, grief, and despair about the worldwide pandemic and the lack of leadership in our country. We also commiserated about how much we missed seeing each other in person.
Therapy generally involves creating new ground as you go. From a psychoanalytic and a spiritual point of view — my work integrates the two — it’s essential to make room for whatever emerges. Desire, fear, confusion, rage…all are fair game. Just lead with curiosity, not criticism, I tell my patients. So, three months into lockdown when I found myself yearning for a walking session with my patient Bella* instead of our usual Skype call, I tried to take my own advice and approach it with an open mind.
As a psychoanalyst, my work is held together by a frame. The frame is the set of ground rules that lends psychotherapy structure and a feeling of safety. It includes the setting, day and time of sessions, as well as an understanding of the process and purpose of coming together. The frame creates boundaries that provide the consistency and predictability that make psychotherapy possible. It is the foundation for trust-building that enables patients to bring their deepest intimacies and fears and passions into the room — to expose their truest selves.
Bella and I had been meeting for years several times a week. An underlying theme in our work had been Bella’s lack of nurturing. She was also working on accessing her feelings and connecting with others in more balanced relationships — something not easy for her, as she doubted her worth. I’d helped her through retirement, the death of her husband, and a move. Despite her negative self-perception, Bella was well-regarded and loved. As her analyst, I admired her deep-seated longing for change even as an octogenarian. She was smart, talented, funny, and attractive.
In the early months of the pandemic, Bella began each session lamenting, “This is going to go on forever.” I knew she needed others to share her experience in order to validate her own, but I hated hearing those words. Wasn’t enduring lockdown hard enough? Even if she was right, I felt she was creating more suffering by clinging to her thoughts focusing on what was lacking instead of being thankful for her health and each day. Yes, sheltering in place was likely to be our new way of life but we would adapt and find new ways to live. My optimism was bumping up against her nihilism.
So, when I thought about having a session outdoors, I got excited. For Bella, it felt wonderful that I had asked if I could come up to see her. In a recent opinion piece in The New York Times, Jerry Seinfeld wrote, “Energy, attitude and personality cannot be ‘remoted’ through even the best fiber optic lines.” Reading it, I agreed. Bella and I were grateful to be able to see each other online, but pixels were no substitution for being together. If I could hold the frame — prevent it from becoming too loose, a casual walk — we could take our patient/therapist relationship onto new ground, literally and figuratively.
She was used to going for walks during quarantine, and I had a car to safely get to her. But I worried. The possibility of endangering Bella’s safety frightened me. Distracted by our discussion she could fall during our walk. Or what if she tested positive for Covid after the session? More minor but still a consideration, what if we ran into someone she or I knew? Protecting her privacy and ensuring confidentiality were essential.
We addressed these concerns over Skype but there were still others I had to take up on my own. Would I jeopardize my family by seeing a patient in person, even outside and wearing masks? Was I impatient for giving into my frustration with tele-therapy? The fear and doubt lessened after hearing from peers — other therapists — early in the pandemic who wondered if it was okay to meet a patient on a park bench for a session. Therapists everywhere were irritated with the constraints of the pandemic, even if also grateful for the connections the technology afforded. I knew I wasn’t the only one starting to think creatively, but as far as I could tell, I was going to be the first among my close colleagues to venture out.
In the end, after weighing the pros and cons, we decided to meet in person. I checked the forecast for the week, and she and I settled on a day, time, and corner. At the designated hour she would be waiting on a bench for our masked and socially distanced walk. She later wrote, “Waiting has been the story and trauma of my life: Waiting for my mother…a friend…But I didn’t have to wait for you…I looked up at 11 and there you were.”
We delighted in seeing each other for the first time in over three months. But I never could have imagined what happened next. When we got to the entrance of the park, she bumped into her next-door neighbor returning from a jog. “This is Annie!” Bella blurted out. “She’s my therapist. We’re having a walking session!” Her neighbor backed away, speechless and determined to regain her six feet of distance. Bella was left standing humiliated and rejected. Her session was well underway.
She was shaken, her initial excitement having given way to shame. And there it all was: her lifetime desire to be liked and seen; the pain of people turning away; the ache for what “still lives inside me as the primal wound,” as she’d put it before. For a minute she flayed her neighbor, but in no time shifted to attacking herself for behaving like a child.
As we walked, I reminded her what she already knew about her neighbor — that she doesn’t do feelings — and that her interpretation of and response to her neighbor’s behavior had more to do with Bella’s own negative self-appraisal than with what had actually occurred. It didn’t take long for Bella both to see things a bit less severely and to find some compassion for the little girl inside who still longed to be seen.
Feeling held by me during our walk, Bella could relax and acknowledge these unmet needs. “Seeing her and my response to her was seeing a distillation of my life,” she emailed me later. My sense was that in the end, being in nature, free from the physical limitations of my office, allowed something to happen that I could witness and help her with in real time — something that never could have happened in our usual office setting. It also helped offset the less-than-loving response from her neighbor. At one point, she paused to show me an old, towering tree, and then a fat tree trunk that had twisted itself around a fence like a sculpture. I knew these, too, were deviations from my normal framework, but they felt good, even right.
Going outside the frame, while still holding it, doing something different can bring growth and reward. If you make room for what emerges breakthroughs can happen, advances can be made. Risk comes with the territory but there is always something to be gained.
If I’m honest, in deciding to walk with Bella, a part of me wanted to make her feel that she was special. I recognize now my own falsely held belief, akin to Bella’s, that a good-hearted gesture automatically elevates the receiver’s self-worth. As Bella learned with her neighbor, looking outside yourself to find something essential you are missing is never a good idea, since it so often disappoints. It’s okay to feel good about something given to you, but real change, the real building of self-worth, happens when you find compassion for your own disappointment and pain.
In the expansiveness of the outdoors, Bella considered her initial punishing response following the run-in with her neighbor until it morphed into something warmer. The walk helped her see herself more realistically and further understand her neighbor’s limitations. Bella still struggles to take in a good feeling because, as she says, they always go away. She’s right — nothing is permanent — which is why it’s important to appreciate and even revisit moments that are meaningful in our lives. Thus, I will never get tired of reading these words which appeared in my inbox the day after our walk in the park:
“Thank you so much for coming up today. Your kindness makes me cry.”
*Patient’s name has been changed to protect their privacy