Weeks ago, before social distancing had embedded itself in the cultural lexicon, a patient of mine booked a trip to Japan, despite an advisory to “exercise a high degree of caution” when considering travel there. Surmising the personal importance for her of taking this trip, I ventured a tentative expression of concern in the form of a question about her thoughts and feelings on traveling, given the risk involved. She acknowledged the risk, ultimately brushing it aside in favor of focusing on the great opportunity before her, and said that she’d see me in several weeks to resume our sessions. As far as interventions go, my tacit expression of concern was a swing and a miss, failing to prioritize her safety as well as alleviate my own incipient anxiety.
The COVID-19 pandemic constitutes a challenge for clinicians by undermining the usual therapeutic setup, a mutual but asymmetrical balance of participation and power in which the clinician attempts to create a space for clients, to contain their anxieties, and foster a sense of agency. However, concepts like mutuality and asymmetry become strained when both patient and therapist are in the same fledgling boat, facing the same overwhelming uncertainties. In this way, the pandemic may be thought of as a “limit situation,” a term coined by the existential-phenomenological psychiatrist Karl Jaspers to describe our experience when the fabric of consensus reality peels back slightly, exposing the ontological bones of existence and the edge of our ability to make meaning out of the “antinomies of life.” As Cristoph Mundt puts it, limit situations are the “super-individual challenges intrinsic to existence, thus unavoidable, and requiring a personal response.” As we settle in for an uncertain duration of remote sessions, it is increasingly clear that whatever expertise or “authority” we rely upon as a result of our training or experience feels less than satisfactory in meeting the relentless anxiety of our patients and ourselves.
Of course, clinicians pull this sort of double duty all the time. The late Jeremy Safran wrote extensively about the varieties of internal struggle taking place between our desire to help—to say nothing of fixing—and our sense of futility that arises from its impossibility. In one paper, he describes how clinicians must manage feelings of impotence or inefficacy while simultaneously empathically joining patients in their own despair. However, the pressure cooker times in which we live—when injury is added to insult already added to injury, ad nauseum—tend to amplify this sense of a double duty to hold space both for ourselves and our patients to an uncomfortable degree. Who holds space for us in these moments? The question that I posed to my patient was as much an expression of concern for myself as it was for her—of my safety upon our reunion when she could possibly be carrying the virus asymptomatically (and when reuniting for sessions face-to-face still seemed like a genuine possibility).
Far removed from that naive time, the dim hum of anxiety has become a surreal roar, and the ordinary discomfort most clinicians experience when our own needs—for safety, recognition, and whatever else—risk eclipsing those of our patients’ feels vastly different. However, insofar as limit situations call for a personalized response, for us to grow existentially against circumstantial boundaries of comprehension and meaning-making, the present moment can become an invitation to respond authentically. Safran unpacked the evolving notion of authenticity, tracing it from Kierkegaard and Enlightenment Europe, through the French and German existentialism of Sartre and Heidegger and its many distortions during the “American Century,” before emerging as a theoretical and technical cornerstone of the relational turn in psychoanalysis. In this context, the concept of authenticity came to stand for both a disciplined spontaneity of response, rather than a rote or “canned” application of theory, as well as the assumption of an ethical stance or reflective sense of responsibility toward deciding which theories or techniques we apply with a given patient and why.
This latter point seems especially rooted in the relational appreciation of psychoanalytic theory as a plurality, rather than as a monolithic representation of any one “school.” Still, under the deracinating effect of limit situations “the rug is so to speak yanked from under my feet,” according to Jaspers. Per Thomas Fuchs, the roof is ripped from our “housing,” the ossified assemblage of worldviews, attitudes, and concepts that serve as a buffer between us and the existential questions which might otherwise keep us up all night. In light of this—and in the shadow of COVID-19—though we may freely be able to choose which theories and techniques to apply, we may no longer hide behind them.
Safran’s clinical writings on nonduality may provide an aid in thinking through this dilemma of authenticity. He contends that duality is a problem insofar as we miss out on what is right in front of us—“suchness,” in his Buddhist parlance. We fail to see the possibilities under our very noses when we become fixated on the widening gap between what is and what we would like to be. The helplessness engendered in us by our implicit sense of this gap as we attempt to go on with business as usual with our patients is likely to hinder us clinically. Better, then, to embrace each aspect of our duality and incorporate it into our work, becoming both the ideal therapist and the flawed human. By attempting to dispense with our own idealized estimation of our ability, we become more cognizant of what we can offer our patients. By letting go of the desire to bask in certainty and triumph in the aftermath of a session, we become emotionally available to feel content with its reality.
This “optimal disillusionment,” as Safran calls it, bears a resemblance to Wilfred Bion’s aspirational advice to enter sessions “without memory or desire,” instead cultivating what he called “negative capability,” following the phrase coined by poet John Keats. Modeling this capacity to drop any pretense and accept what cannot be known for our patients can be a powerful experience on both sides of the proverbial couch. However, it also highlights the perils of dependence as one of the biggest factors in maintaining a dualistic sense of ourselves and our skills. For one, the idea of admitting that we just don’t know can be frightening, as some patients depend upon their idealized perception of us as experts in order to engage in therapy. Further, decisions forced by the threat of COVID-19, such as the shift to remote sessions, risk our livelihood, as some patients inevitably declare that teletherapy isn’t “their thing,” or decide that a shift in modality coupled with financial strain provides just the nudge that their ambivalence pulls for in order to postpone sessions until things “return to normal.” These decisions, which could be viewed as a necessary kind of prosocial modeling during a time when our patients may feel otherwise inclined, nonetheless cast doubt on our personal and professional identities as self-contained clinicians, for what is a clinician without patients?
This also casts into sharp relief structural flaws in our clinical training, such as the point by Middle Group analyst Charles Rycroft that we “are expected to make moral decisions and to provide hope for the despairing, while pretending that [we] are exercising professional skills derived from scientific knowledge.” Rycroft goes on to note that hope itself is interpersonally mediated and requires replenishment from sources external to the self, like the mother, originally, or the therapist, who initiates the therapeutic relationship as a “symbolic interaction…between one who has hope and one who hopes to acquire it.” However, Rycroft was smart enough to realize that the patient’s view of the analyst as “one who has hope” was primarily illusory, and that part of clinical work entails holding open a space for hope when there may be none to be had. Only now, the space we’re holding open must be big enough for two, which brings us back to the notion of authenticity: how do we, as bearers of hope, respond empathically and genuinely to our patients during a time when we ourselves may feel bereft and without latitude to maneuver clinically?
As far back as Heidegger and Sartre, agency and authenticity have been regarded as intertwined concepts, coalescing around a stark resolution to face the loneliness and individuality of one’s relationship to limit situations such as death, freedom, and meaninglessness. Conversely, inauthenticity has traditionally been conceptualized as a flight from this imperative into the banal world of social “everydayness,” to use Heidegger’s term. Currently, culture is increasingly “valorizing autonomy, and pathologizing dependency,” Safran writes. In light of Safran’s commitment to championing a relational concept of agency as a dialectic between cultivating a realistic sense of self-sufficiency and a genuine capacity for surrender and dependence, a relational view of authenticity must necessarily follow. Similar shifts in perspective are beginning to occur in neighboring disciplines, such as philosophy, where Shaun Gallagher and colleagues have written about the inextricably intersubjective nature of our being-in-the-world-with-others. Thus, it makes far more sense to regard inauthenticity as the opposite of its historical definition—a denial of the messy interrelatedness of being human with other humans, and all of the risks and rewards entailed by our collisions as subjective centers of our own shared reality.
The tendency now in this new period of self-quarantine is to separate from one another in order to increase our subjective sense of agency, our conviction that, despite the overwhelming uncertainty of the situation, we are doing all that we can. While this is undoubtedly wise when applied to physical proximity, it may be antithetical and ultimately contraindicated psychologically, cutting ourselves off from sources of hope and psychic nourishment in others.
For patients, this might look like the adoption of the attitude that therapy is a frivolity or luxury during a time of austerity, or the confusion of a resignation to spinning their wheels, anxiously poring over sensationalized news stories, with the belief that they are being realistic and pragmatic. For clinicians, the temptation to facilitate the most productive sessions (as though such a thing were possible), to keep people motivated and interested, and to quell their anxiety—and our own—may lead us to hide behind rigid theoretical constructs in a desperate attempt to become the ideal.
Limit situations are occasions to grapple with and transform ourselves through our understanding of what it means to exist. To do so authentically is also to grapple with other people, rather than retreat into isolation (socially, theoretically, intellectually) or into mind-numbing everydayness (memes, social media challenges, etc.). We must put it all onto the table, socially, in pursuit of creating something spontaneous and vital. Scary as it is, the COVID-19 pandemic perfectly illustrates the kind of mindful creativity that we can awaken to when the gears of everydayness grind to a halt. It also serves as a reminder of how inherently relational our shared existence is. People are more physically isolated than ever before, but are becoming more connected and genuine, expressing care and concern for others, finding new ways to be together, and realizing our fundamental need for connection and relationships. Instead of illusory self-sufficiency, we are realizing our capacity for mutual aid.
Nick Fehertoi is a post-doctoral psychologist at the Williamsburg Therapy Group in Brooklyn, NY and a graduate of the New School for Social Research’s Clinical Psychology program.