COVID-19,Limit Experiences,and Undergoing the Situation: Therapeutic Implications for Pandemic Times

Abstract

Living in a world affected by the COVID-19 (coronavirus disease 2019) pandemic presents unique challenges to the therapeutic endeavor. One such challenge is mutual sharing in the collective anxieties and stressors befalling communities globally. This article will seek to explore and understand these shared concerns through a Jasperian framework of limit experiences, particularly explicating the impact on therapeutic practice. Concepts such as emotional comportment and dwelling will be explored and recontextualized as possible responses to such limit situations.

At the time of this writing, global coronavirus disease 2019 (COVID-19) pandemic has swept the planet in a matter of weeks. As a result, it has caused significant health concerns, severe economic downturn related to business closures (voluntarily and by governmental declaration), and limited resource availability—to name a few. Given the rapidity with which these sanctions and effects have occurred, in turn, immense coextensive feelings of anxiety and uncertainty have arisen, such that accurately predicting the changing tides of each new day is nearly impossible. Indeed, with some predictions estimating that up to 70% of the world risks eventual infection, it is likely that, though physical survival rates remain high, very few will remain psychologically unaffected (Petropoulos & Makridakis, 2020).

In the midst of these escalating concerns, mental health professionals remain “on the front lines” in providing care, whether in-person or tele-therapeutically; however, there is little immunity or solace from such distress, as they are consistently confronted outside of their work with the self-same anxiety and uncertainties articulated by their clients. In response to these shared anxiety-provoking experiences, questions regarding how one relates, what is helpful, and what it means to be present arise and must be revisited to address the unique context in which they now exist. Utilizing a Jasperian (1919) framework, I will seek to contextually frame and answer these questions as a type of “therapeutic” limit experience at the intersection of reactions to COVID-19, offering a unique relational challenge to mental health providers engaging with their clients. A discussion of comportment and mutual grieving as emotional dwelling (Atwood & Stolorow, 2016) will be discussed and recontextually defined as possible responses to these challenges.

General Therapeutic Organizing Principles

To address changes to therapeutic frameworks or practices related to COVID-19 as a possible limit situation, it will first be necessary to highlight some relevant factors related to how psychotherapy is normally understood and conducted, with specific emphasis on existential and humanistic psychotherapies. Echoing Todd DuBose (2015), the psychotherapeutic process serves to create an atmosphere in which “change, acceptance, reconfiguration, and/or understanding” may take place (p. 25). Throughout, one attempts to enter the client’s experience and consistently respond and relate to them in such a way that their lived experiences may be described and articulated, opening what is presented to mutual witnessing and understanding. Strong evidence suggests that these qualities make up much of the evidence underlying what makes psychotherapy effective (Benish et al., 2008; Wampold et al., 2007).

In such attempts at entering, the therapist is not merely confronted with a diversity of perspectives that may differ from their own, however, but always risks being radically affected through the relationship with the other (Orange, 2014). For better or worse, the latter possibility exposes the clinician to the full visceral nature of the painful experiences endured by their clients, which may often feel challenging to fully undergo. One method by which distance may be created is through the adherence to and sustainment of a theoretical worldview. This worldview, at its base level, is a “thing-ified” assumption, belief, or narrative through which the clinician comes to interpret and conceptualize the client’s presenting experiences, how the therapy should operate, and what may be most helpful. As Stolorow and Atwood (2013, 2017) discuss, these theoretical notions often operate as a type of “metaphysical illusion” that shield the clinician from the full weight and existential vulnerability of the client’s experience, offering an important self-care boundary and experiential reprieve. If not closely monitored and attended to, however, the same self-protective functions provided by these worldview orientations may quickly gravitate toward objectifying the unique context-embeddedness of the client’s suffering, reifying a self/other distinction that creates barriers to the clinician’s desired experiential entry.

Managing the tension between the raw and painful affect presented by a client and the psychotherapist’s cherished worldviews remains a constant experiential challenge. As such, recommendations for clinicians to create a balance between their and their client’s subjectivities range in emotional intimacy, from evenly hovering attention to participant observation and empathic immersion (Atwood & Stolorow, 2016, pp. 103-105); however, inherent in all of these approaches exists a dictum to create a tolerable and safe distance from the potentially agonizing affect presented, therein, functioning as a sort of lifeline from which to navigate a return from client’s experiential world. It stands to wonder, though, when confronted by such challenging circumstances as the COVID-19 pandemic, whether such metaphysical illusions remain viable as protective barriers and, if not, what new approaches may arise in their wake?

COVID-19 as a Limit Situation

Introduced by Karl Jaspers (1919) in one of his early works, Psychologie der Weltanschauungen (Psychology of Worldviews), a “limit experience or situation” may be understood as a single or series of experience(s) that challenge or press up against the constraints or boundaries of one’s currently lived worldview. On occurring, one enters a liminal space betwixt and between familiarity and the uncertainty regarding the intelligibility of reality, which usually confers coextensive feelings of dread or anxiety. Following closely, Heidegger (1927/1962) claimed that stepping into this liminal space may collapse the comfortable boundaries of and absorption in one’s worldview, creating a sense of uncanniness (Unheimlichkeit)—no longer “at home” in that world previously inhabited.

For Heidegger (1927/1962), the experience of leaving the “home” of one’s worldview cooccurs with a radical taking ownership of one’s existence as an individual, which ultimately discloses the historic evasion of their recognition of death as an unpredictable possibility. The recognition of one’s finitude, however, can be interpreted beyond the parameters of its physicality. Indeed, actual or anticipated loss of what matters to an individual or community may also be experienced as a type of narrative death in recognition of the closing down of previously anticipated experiential possibilities. Existential anxiety, then, inherent to the limit situation of exiting one’s worldview, “anticipates both death and loss” (Stolorow, 2011, p. 287).

As COVID-19 has proliferated into a global pandemic with an unprecedented rapidity, affecting every individual and community in some form, there is growing tension in the recognition that the possibility of returning to life as it was prepandemic has been lost. Stated differently, COVID-19 functions as limit situation, confronting each person with the fragility of their worldview and loss of experiential possibilities, therein. Despite everyday practices eventually returning to some sense of normalcy, such as social distancing measures lessening and individuals returning to work, many scaffolding assumptions regarding human specialness and invincibility have been challenged. Globally, inequalities related to gender, socioeconomic status, access to health care resources have been exposed as inadequately structured and tenuous (Alon et al., 2020; Garfin et al., 2020). Individually, crippling anxiety and dread have become commonplace regarding the uncertainty of the future and what is means to be safe and healthy (Qiu et al., 2020).

Sharing in these affected communities, clinicians are not immune from the social, economic, and psychological consequences of the COVID-19 pandemic. Indeed, the self-same anxieties experienced by their community and, therefore, potential clientele exist for and present unique challenges to the clinician in the therapeutic endeavor. As noted above, many strategies often utilized to create a sustainable boundary between self and other or protect against vicarious traumatization may no longer operate as effectively, if at all. Whereas the clinician might have historically risked entering their client’s experience more vulnerably, knowing that once their sessions ends, they may find reprieve in returning to the safety of their own experiences and circumstances, this possibility no longer exists. Instead, the clinician must now contend with same collective anxiety and concern as their clients, returning to an experiential world equally annihilated and uncertain. In turn, a unique challenge presents itself as to how the clinician may leave the now crumbling safety of their own experiential world to enter the client’s, knowing that there will likely be no reprieve on return.

From Transcendence to Radical Emotional Dwelling

For Jaspers (1932/1969), addressing limit situations required their transcendence. In a fundamental reconstruction of Kantian themes, Jaspers purported that one must overcome fixed attitudes and abandon the monological structures of consciousness that the limit situation exposed. This was accomplished primarily through a type of committed communication toward becoming more reasoned. This approach has been challenged, however, in that seemingly “un-understandable” experiences from the clinician’s perspective are presupposed as closed to becoming more dialogically transcendent (Bentall, 2018). At best, this approach may result in a type of “self-help”; at worst, it may result in greater shame, cast into isolation of one’s experience.

Anticipating the potential for retraumatization in the above-mentioned approach to addressing limit situations, Stolorow (2014) recommends a more active and engaged emotional comportment, which he calls emotional dwelling. He notes,

In dwelling, one does not merely seek to understand the other’s emotional pain from the other’s perspective. One does that, but much more. In dwelling, one leans into the other’s emotional pain and participates in it, perhaps with aid of one’s own analogous experiences of pain. (p. 81)

In doing so, one risks enduring the other’s potentially traumatizing state but may be rewarded with a language reflecting greater adequacy in comporting their pain, therein, which might gradually transform it into more bearable affect.

Given the experiential and relational challenges presented by the COVID-19 crisis, I propose an even more radical contextualization of what it means to emotionally dwell with another in the therapeutic situation. Within Stolorow’s (2014) definition, there may exist an assumption that the clinician can choose and define the parameters through which they attempt to enter and dwell in their client’s experience. This process of choosing would function as the same type of aforementioned lifeline, allowing for return to the safety of one’s own experiential world and possibly encouraging greater retreat from or hesitation in attempting to meaningfully undergo a client’s experience. As noted, however, that choice may no longer exist, necessitating a new set of defining characteristics regarding what it means to cocreate an emotional dwelling.

Extending the metaphor of the lifeline in returning to the safety of the clinician’s worldview, I contend that emotionally dwelling in the context of the COVID-19 pandemic merits a letting go of that lifeline in order to fully embrace the client and the world as they presently exist. Attempting to hold both the lifeline and the client may communicate a lack of commitment on the part of the clinician to remain present, simultaneously signaling a desire to avoid the terrifying reality of the client’s experience and a retreat to the security of an experiential world that no longer exists. Engaging in this manner in the therapeutic interaction, then, may look distinctly different. Several examples come to mind: The clinician might increase levels of self-disclosure and more frankly answer inquiries about their well-being, rather than respond with curiosity about the client’s inquiry. Additionally, the clinician may welcome or participate in previously unseen digital views into the client’s life and home, appreciating them as vulnerable disclosures rather than superficial avoidance measures. Finally, the clinician may allow room for them to be comforted, engaging more fully in a true dialogue in which each person shares a “kinship-in-the-same-darkness” (Stolorow, 2015, p. 135).

This approach to psychotherapy during the unique context of the COVID-19 pandemic seeks to embrace and extol Gadamer’s (1975/1991) understanding of true dialogic encounter. In it, he states that “the person with understanding does not know and judge one who stands apart and unaffected; but rather, as one united by a specific bond with the other, he thinks with the other and undergoes the situation with him” (p. 288). Emotional dwelling, in this manner, seeks to reduce therapeutic power dynamics, as there is permittance to lean on one another, grieve together, and ultimately humanize each other. In acknowledging and allowing the mutuality of such existential loss together, we may simultaneously find safe passage into new and adaptive experiential worlds.