- Moving into the next stage of the pandemic requires taking stock of your personal tolerance for risk.
- Adjusting to heightened risk is nothing new.
- Budgeting for risk is a personal, ever-changing choice.
In the early days of the pandemic, as the world was adjusting to a rapidly changing viral landscape, I co-chaired the COVID-19 Advisory Committee for the American Psychoanalytic Association. We closely followed the advice of the CDC and top medical experts; we also reviewed and conducted surveys related to COVID concerns among our members. We produced informational letters, blogs, videos, and podcasts relevant to the adjustments to moving therapy online in this time of COVID. Keeping up with these changes was practically a full-time job.
This shift in focus drove a major adjustment for most clinicians: moving our practices online. In the early days, only 20 percent of our field had substantial experience using online therapy. The worldwide shift was both immediate and massive; it called for multiple educational efforts, consultations, and a whole support network to help people get up to speed. As time went on, bigger questions arose: Do we stay this way forever? Do we give up our offices for good? The sometimes awkward learning curve led to the development of literature about best practices for online psychotherapy and psychoanalysis, as well as differentiation about when it was necessary to see clients in person.
It wasn’t just practicing psychotherapists who had to make accommodations, of course. Teachers of every stripe, from kindergarten to graduate school, found themselves confronted with having to learn a completely new skillset: online teaching. (The International Psychotherapy Institute, of which I am a founding member, offered to help develop particular expertise in this since we had been doing online education for more than 20 years.) These resources became useful to people as they made the transition, settling 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 is no longer new; it has become part of the way we live. COVID risk continues to factor into our behavior, of course—but instead of a menacing thrum, it is now more like white noise: constant, ubiquitous, and largely benign.
Moving into the next phase
One thing we know for sure: COVID will never truly be “over.”
Epidemiologists tell us that it is heading toward an endemic phase; in practical terms, this means long-term adjustment. Most of us have decided whether to go back to the office or not, adjusting to patients who prefer to meet online (and others who insist on returning to meeting in person). As mandates become merely recommendations and political tensions subside, some feel stuck in the middle. What happens next?
Many of us are balancing the demand for online sessions with what often feels like screen fatigue. We struggle to know how safe is too safe, even as extended social isolation is known to take a toll on our mental health. Many younger colleagues, still in the prime of their practice, find that their need for offices has diminished—while in-person networking and training events are once again becoming common. Still others of us simply worry… about worrying too much.
A fractured political landscape, new discoveries about the virus, and growing demand to return to normal have made “what to do” increasingly unclear. One certainty is this: We all must now adjust to a new way of thinking about COVID in our lives.
Finding the “right” level of risk
Given the mixed regulatory signals, generally decreasing but still oscillating infection numbers, and our own rapidly changing personal circumstances, deciding on our tolerance for risk is now harder than ever. Unless we stay forever socially distanced, we must accept risk while attending events that will sometimes lead to spread. While the effects of “long COVID” are still unknowable, we also know the psychological risks of staying too closely cloistered.
While no one has all the answers, it may help to bear the following points in mind while choosing a course of action:
1. We all face the risk of contracting COVID.
With any social interaction—large or small, indoor or outdoor, 100 percent vaccinated or 100 percent not—we must accept some level of being exposed. We’re all going to have to calculate from one event to another and one day to another how much risk we are willing to accept.
2. Adjusting to heightened risk is nothing new.
We’re entering a transitional period in human history, but this certainly isn’t the first time. Just as the world was shaken and then made to adjust to the tragedy of 9/11, so will we have to adjust to the reality of COVID. The same adjustment happened after the Cold War and, nearly 100 years ago, after the pandemic of 1918. And now we are also carrying the sense of risk to the world that emanates from the war in Ukraine! The risk from COVID may be somewhat permanent—but our heightened fear about it, most likely, is temporary.
3. Budgeting for risk is a personal, ever-changing choice.
Our tolerance for risk may rise or fall depending on our immune systems, our jobs, or the needs of our families. How each of us is going to live with the knowledge of continuing endemic risk has yet to be determined, but it is clear that we should continue to be aware of our ongoing calculations.
This month, our COVID-19 Advisory Committee decided to sunset. COVID itself has not “sunsetted,” of course—it has just become part of the atmosphere—but offering guidance and support for the choices we now face is a job best allocated to conversations with one’s trusted friends and counselors. Our final words of advice could be applied to COVID risk as easily as any other element of psychological health: Be mindful of your emotional needs; communicate your needs and boundaries; and be patient with those with different perspectives on risk.