Pivoting the Couch: Creating Therapeutic Spaces During a Global Crisis

Like many, when Covid-19 initially struck I packed up my school-based office and scrambled to figure out how to provide telehealth services for the first time. Despite the stress of fumbling through this I felt assured that within two weeks- a month maximum, we would all be back to our offices and our lives. Children would be back in school, parents and others back to work, life would go on. What would unfold would leave not only myself, but others awestruck in the saddest possible ways. I watched as Covid-19 took root across the United States affecting those both young and old. I watched as beloved front-line workers, many of whom were therapists also contracted the virus. Despite this, I remained hopeful that we would be able to contain the virus and return to life as we knew it. My clients, teenagers, struggled with the transition to being home and maintaining schoolwork. Quickly, not only did I become a tele-therapist, but a resource case manager. I spent all available moments looking for community resources for my clients while assuring them although things were swirling around them, therapy could remain.

Within a few weeks, I was struck with the realization that tele-therapy was here to stay. My cozy office with its spacious couch and ambient lighting was gone. It was time to create that space virtually for my clients.

What appeared to be a beautiful window backdrop complete with fairy light accents that just happened to be in my home, was in reality, a hastily thrown together backdrop created on a bare wall in a corner of my home devised with decorations for a baby shower that Covid-19 prevented me from throwing for my dear friends. That curtain served as a welcoming environment for my clients who had already lost all sense of normalcy. Their loss was coupled with my own. I helplessly listened to my client’s loss and sadness while attempting to address my own. The burdens of it all were heavy and my ability to help myself and my clients often felt minimal. While I had once been able to at least provide these teens a safe physical space for an hour, now they were often at home with many siblings and problematic dynamics that were on display in full force. My heart was heavy but alas, therapy persisted.

The teens and I found routines in our sessions and ways to make tele-therapy nearly as welcoming as it had been. The world continued to swirl, but for those 50 minutes things seemed a bit more normal, sometimes even more so as we all adapted to having therapist and clients virtually in our most private spaces, our homes. We had all begun to cope as much as we could with the ever-changing world and CDC guidelines. The therapeutic space was working, and things felt manageable on the “virtual” couch until once again things changed. Mandates came, school were to return to inperson learning. After 5 months of virtual therapy, it was time to re-enter my office and once again pivot. When I re-entered my office the third week of August in preparation for my clients return to school and therapy, the dusty daily calendar still read March. It felt like a lifetime has passed during those 5 months.

My teen-friendly office was a CDC-guideline nightmare. There was not six foot of space for social distancing, there was a communal fidget basket, snacks, markers and coloring pages for sharing. I looked around at my cozy space and pondered how I could make my space safe without it feeling sterile and cold. I rearranged the room and rearranged it again. A tape measure signaled my success at creating social distancing space and a sign indicating the need to wear a mask in session along with a bottle of hand sanitizer replaced my candy bowl. A basket of disinfectant replaced my fidget basket.

Once the physical space was created the magnitude of what I was about to undertake hit me with unrelenting force. I was bringing clients into my office who had the power to infect myself and others with Covid-19. Not only would I be sanitizing after every client, I would be providing therapy in a mask. Everything I learned about minimal encouragers and being attuned to my client’s facial features was gone. How would my clients react to my changed office space and not even being able to see my face? On August 31, 2020 I would have the answers to these questions and some that never occurred to me. My clients were brought into the office over the course of that first week and guidelines were explained. I joined my clients in the feelings of uncertainty about what would come next. We blinked over our masks and I hoped the pensive smile under my mask would show through sincerely.

My clients adapted to this changed therapeutic space and braced themselves for more change. Soon, cases of Covid-19 were occurring within the school system and clients were being quarantined for 10-day increments. Now we all live between the virtual world and in person therapeutic services. Therapeutic spaces are precariously moved through back and forth as if to prevent us all from becoming too comfortable. Here in 2021, the world is continuing to swirl.

So, what advice would I have for therapists looking to create a therapeutic space and pivot their metaphorical couch?

1. Realize that for many it is your empathetic and steadfast nature that is the therapeutic space.

2. Self-care is important. Like empathy, burnout is palpable. Providing therapy through a screen or speaking through a mask for any and all social interaction is exhausting and isolating. While facials and bath bombs are great, what rituals and activities are you taking part in to fill and renew your heart and

3. Create a physical space you enjoy being in whether that is in your physical office or a make-shift virtual office at home. If you are providing therapy in your home create a dedicated office space or section within your home to allow yourself to create boundaries between your home and your work. My experience with creating a therapeutic space during a global crisis highlighted that therapeutic spaces, like people, can and will adapt and remain. While our hearts may be heavy, they are still welcoming and beating hope for our clients.

Written By: Jessica Yanson, LMFT, LMHC, CRC

Jessica currently works for a school-based nonprofit as well as in her private practice, Cultivating Healing, LLC. Jessica works with teens and adults specializing in work with highachievers, anxiety, chronic illness, and those affected by Covid-19. Jessica has a passion for working with those from marginalized communities including the LGBTQIA+ and disability communities.