Bathtub psychotherapy in the age of coronavirus

(Hannah Agosta for The Washington Post)

Jack Turban is a resident physician in psychiatry at Massachusetts General Hospital.

I’m a psychiatry resident at a major hospital in Boston, and I have tested positive for covid-19. People my age (30) have died from this virus, but I am lucky to have had mild symptoms. At first, I had splitting headaches and was exhausted. I’m down to a mild cough and an inability to smell.

With my health recovered, I have a new problem: How am I supposed to be a psychiatrist while I’m quarantined in a studio apartment? Our hospital system got telehealth visits up and running quickly, but I have no privacy. As I type this, my partner is lying in bed coughing and trying to take conference calls. My puppy is running around between us, chasing his tail.

But I won’t give up on my patients. Mental health might not seem like a priority right now, given that most people are more worried about their lungs than their emotions. But this is exactly the problem: We are suffering from widespread worry, which can lead to widespread anxiety or depression. So despite the social distancing, we therapists must go on.

This will not be without its challenges. My patients expect confidentiality in our therapy sessions. In my usual office, surrounded by thick walls and white-noise machines, they tell me their most private secrets. We spill everything: their problems with sex, considerations about breaking up with their partners, private resentments toward their children. They’re not looking for input from my boyfriend, and they don’t want him to hear our conversations. So far, he’s agreed to go outside while I’m seeing patients. Now that he’s also probably positive for covid-19, we’ll need a new solution. Right now, like much of the world, we don’t have a clear plan.

My patients also complain that they don’t have privacy on their side of the phone. Working from home with their families, most don’t have a private space to talk with me. Young children are barging into the room asking for snacks. Sometimes spouses are only a few feet away. Are they eavesdropping? Sessions have become strained as patients censor themselves in front of their families. Therapy on display is not effective.

Some have found creative solutions. Parked cars are now popular therapy destinations. Locked bathrooms, too, and many bathtubs have become psychotherapy couches. For those who can go outside, abandoned parks and long walks have also helped.

But some types of psychotherapy require in-person contact. The gold-standard treatment for social anxiety disorder is cognitive behavioral therapy. The final phase of treatment involves exposing people to what they are most afraid of: face-to-face social interactions. By living through these anxiety-provoking social situations, patients can overcome their fears. But I can’t tell a person to go talk to strangers in a crowded space while the governor is telling them to stay in their homes. We’ll get creative through FaceTime conversations with acquaintances and chats with strangers via online social platforms.

I do worry these approaches won’t be successful. My patients are calling and paging me with concerns that they’re going to die from coronavirus (for most, this is unlikely). Others tell me they’re afraid for their elderly relatives. Since the coronavirus crisis started, calls to suicide hotlines have surged.

Usually patients who are worried they will hurt themselves at home are admitted to psychiatric hospitals. In the age of coronavirus, though, what’s more dangerous: staying at home, or going to a crowded psychiatric unit and risking coronavirus exposure? For some patients, hospitalization is still the clear answer, but these decisions are harder to make than ever. This scares me.

Coronavirus is a serious public health problem, and we all need to do our part to curb its spread. Luckily, for an individual, the risk of death from physical symptoms is low. The mental health risks, however, seem to be high. Things are going to be tough, and the same mental health services won’t be available. However, as psychiatrists, we are still here for you. We will find creative solutions, even if it means therapy in your bathtub.

Read more:

Kenneth Paul Rosenberg and Chirlane McCray: Don’t neglect your mental health during this pandemic

David Moscrop: In Canada, an inspiring movement emerges in response to the coronavirus

Jason Rezaian: I survived solitary confinement. You can survive self-isolating.

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