by June Lin-Arlow, AMFT 

“Recently he has become obsessed with things being broken. He is using aggressive language: ‘rotten,’ ‘burst,‘ ‘fall,’ ‘break.’ He will squeeze together some clay, throw it down, and say ‘broken’ over and over again pointing to how it broke,” a parent tells me looking concerned. The identified patient, a 3-year-old boy, looks over at me and scowls, sizing up this new Oedipal rival. He walks towards me and knocks me over. Who’s on the phone vying for mother’s attention? I can't help but smile at how true his words feel about gestures wildly at everything. 

Once things were whole, and now they are broken. The playground was open, and now it is closed. Dance class was fun, and now it is closed. Friends are closed. When people get too close, it is scary. They need to stay away. “When he sees someone not wearing a mask, he starts screaming ‘mommy they’re not wearing a mask!!’ I can’t calm him down, and it’s so embarrassing,” his mother says to me, hands covering her face. How confusing and distressing it must feel to be a little nervous system moving through the world right now absorbing grownup anxieties. 

Another patient, who is a teenager and hasn’t seen other kids for a year, yearns for the rush of playing basketball, scoring a hoop, dodging sweaty bodies, getting high-fives from teammates and cheers from an adoring crowd. Now he seeks that high through an NBA video game, which is an insufficient substitute for human contact and a hungry ghost that demands more and more and more. Grownups are gone doing whatever grownups do, and he sits alone in a cramped apartment all day with the blinds drawn shut. He has been pouring so much energy into the game that he hasn't shown up to virtual school for months. 

Back in March, my agency started allowing fully vaccinated clinicians to meet with patients in person, outside, 6 feet apart, masks on. These conditions were nowhere near ideal, but I immediately went for it with him because I desperately felt like we needed to make contact so that my presence could feel real in some way. I had never actually met him in person, and our sessions were mostly him playing a video game and me spinning my wheels. We walked down the street together interacting with various passersby on the way to the park. “How in the world do I structure a clinical frame?” I wondered as I also worried about finding a good place to settle or what to say if we ran into someone we knew. When we saw the basketball court, and he asked if I wanted to play, I saw his eyes light up for the first time in a year. I realized that I had been holding my breath this whole time and finally started to breathe a sense of relief. At the end of our first in-person session, he looked at me and said, “it was nice to meet you,” as if it was our first time meeting even though we had been working together for almost a year virtually.

As we see the light at the end of the tunnel, at least in the United States, we are reflecting on the use of teletherapy. In Potential Space, Amber Trotter thinks about what makes working through telehealth different from working in person. Even though we’ve been living through the same pandemic, social inequities have made for very different lived experiences. I keep thinking about what Resmaa Menakem says about racial trauma: “Trauma decontextualized in a person looks like personality. Trauma decontextualized in a family looks like family traits. Trauma in a people looks like culture.” Decades later, what types of impacts from this time will we be able to easily attune to and which will get lost and decontextualized?