Self-Care and Resiliency in a Time of Telehealth
by Brittany Rhoads, LCMHC, Adult Outpatient Therapist at Lamoille County Mental Health Services
Perhaps I should consider myself lucky that April has felt like it’s flown by. I know that not everyone can say the same. As we were approaching a new month, my boss sent out an email asking for ideas, articles, Facebook posts, or activities to honor the upcoming Mental Health Awareness month.
I’ll tell you, it’s challenging to be brief when writing about mental health as a collective issue, because there’s no one size fits all. If in this article there’s something that doesn’t sit well with you, or if it feels invalidating, please know that these words aren’t reflective of everyone’s experience. It would be impossible to capture something as monumental as what’s happening in our world right now in a brief essay.
I’ll cut to the chase: If you had told me that I would one day be providing therapy from my kitchen table, I would have laughed. Not at you, of course, but with you. Therapy? At home? From my kitchen table? You must be joking.
Besides, how could that be remotely possible? Insurance companies aren’t exactly excited by the idea of a screen connecting two people as they explore the intricacies of life. Some might wonder, “Is telehealth less effective?” I imagine that many of us who have worked in the community mental health field “Pre-COVID19” would have assumed telehealth therapy would be less effective. At this point, I would respond to that question with, “Ehh, it depends.” It depends on the day, the person, the circumstances, and the topic of conversation.
While telehealth is not ideal for some people, this experience has reinforced my beliefs about how exceptional and resilient the human spirit can be when faced with no other option than to adapt. I should clarify that effectiveness and preference don’t always go hand in hand. I have a feeling that so far, doing our best is enough, but I’ll leave it to the research psychologists to evaluate telehealth’s effectiveness. While I prefer to work with my clients in person, I see the value in telehealth.
In addition to allowing established clients to continue their therapeutic services, telehealth has created a pathway for new clients to access our services. Due to the stigma that can surround receiving mental health treatment, there are times when people feel so ashamed that they can’t allow themselves to access the necessary support. If a person wasn’t able to step into a community mental health office, fearing judgment, telehealth has removed that barrier. Sure, it’s a bit different than sitting across from someone, creating and sharing space with a person.
Metaphorically speaking, I find that participating in teletherapy is like swimming between the islands of an archipelago. In this case, a Zoom session is a small island for rest and recuperation while someone is swimming a great distance. If traditional therapy is a marathon and not a sprint, teletherapy is a team triathlon. It’s not just running a course, but navigating different environmental factors and doing it side by side. It’s 45 or 50 minutes each week in someone’s life that hopefully reminds them that they’re not alone, regardless of where the session is taking place. We can learn to sit with the pain, frustration, sadness, and anger. Of course, we can relish in the joy of the little things, too. We can do it in the same room, or we can do it miles apart.
A friend asked me the other day over a physically distant—but socially connected—Zoom chat, “What do you think the outcome will be from all of this? Like, how will this whole pandemic impact people, even if we don’t see it right now?” I think I made a joke about the fact that I don’t have a crystal ball and I can’t predict the future. Here’s my take on it: What is causing psychological pain right now is similar to what’s caused it before the pandemic. It’s the deeply uncomfortable and painful feelings that have existed within people, long before we were asked to stay home to keep one another safe.
In my mind’s eye, I visualize the pandemic as a large, tumultuous, exhausting, unrelenting flashlight that shines brightly upon the parts of a person that are already hurting. Feelings of abandonment, unmet basic needs, cycles of feeling trapped, someone’s ability or inability to connect with people in their community, the scathing discrepancies between privileged and marginalized communities, unmet needs of physical comfort from another person and no way to safely meet that need, poorly managed stress and painful family dynamics, to name a few. It’s all there. And it’s all been there, the whole time. The pandemic didn’t create these feelings; it exacerbated so much of the pain that was already there.
And while we’re here, talking openly about highly stigmatized issues, can we discuss self-care and what it means? In a world where we are inundated with magazine articles and social media posts about all the ways to take care of oneself, can we just take a moment to pause on what we’re being sold?
Self-care is not all sunshine and roses. Self-care is not always pleasant nor comfortable. Sometimes it means saying no when you need to, or reaching out for help. Sometimes, talking about the most vulnerable parts of yourself is self-care. Not just bubble baths, dark chocolate, and yoga (although I’ve taken at least two of them and I didn’t count the pieces of chocolate, but I digress). What if we looked at self-care as more than just “warm fuzzy” activities that help you to feel good?
Don’t get me wrong, I am all for self-care that feels good. If giving yourself a hot towel manicure works for you, have at it. If binge-watching old episodes of This Old House and learning to build raised garden beds works for you, build on. But what about the kind of pain that sugary confections, overpriced bath products, and a trip to Home Depot can’t heal? What if we looked at self-care in a way that honored the fact that life isn’t always that simple. Pain is inevitable, but suffering? That’s where we have a bit more control.
Marsha Linehan, the founder and creator of Dialectical Behavior Therapy, talks about building a life worth living. She speaks about life as if it were a house. When someone is suffering, that house is set on fire. When the house is on fire, the only meaningful way out is through. It might be painful to escape, but it’s the only alternative to suffering.
What if we accepted the mindset that self-care isn’t an escape, but a way to build a life worth living? What if our forms of self-care taught us that we can sit with our feelings, that we can co-exist with discomfort?
When talking with my clients about opening themselves up, mindfully, to whatever emotion comes their way, I describe one of those old wooden tables. You know, the kind that’s often associated with Grandma’s house and large family dinners? The type with the wooden leaf that slides in the center to expand the table to seat more people. Then, instead of people gathering around the table, visualize emotions. Just like guests at a dinner party, some are expected while others did not RSVP. These emotions arrive, some on time and some fashionably late. Some wait to be invited in, and some others abruptly ring the doorbell, coming in without so much as a, “Hello.” Perhaps they stay for a while. Most of these emotions get up and leave without being directed to do so. They come and they go. Some emotions, on the other hand, need a firm, yet gentle, ushering out the door. Nevertheless, they leave. They’ll come back again, as emotions tend to do.
I have hope that there is light at the end of this proverbial tunnel. I hope that people can shift their thought processes. We need a collective shift to challenge the stigma of mental illness.
I challenge you to consider the way you casually talk about mental health issues. How about changing the language we use to honor that people are people, no matter how they struggle? Just as we’ve moved past the “R-word,” perhaps we can do the same thing with the words “crazy,” “nuts,” and “psycho,” to name just a few.
People desperately need to be able to seek help without shame. And we’re here for that. Until we’re able to open our office doors, we’ll be here by phone or computer. We’ll be here when a person has become overwhelmed with psychological pain, unable to accept parts of themselves that they see as unlovable and unwanted. And we’ll be here when a person who was taught, “talking about feelings is bad,” is thinking about reaching out for help. Deciding to make a change in your life requires courage and vulnerability. It’s worth celebrating—and we’re here for that, too.