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This major excerpt is taken from Derk Replogle’s essay on virtual therapy in “Corona City: Voice from an Epicenter,” published in November 2020 by Magic Dog Press. The book recently won first place for both best anthology and best COVID-19 pandemic book in the international Next Generation Indie Book Awards. Proceeds from the anthology’s sale on Amazon go to fighting hunger in America.
By Derk Replogle, director of Addiction Services at NewBridge Services
I work with people for whom isolation can be toxic, sometimes deadly — those struggling with substance use and mental health disorders. In early March I had many all-consuming discussions with clients about COVID-19. I refocused therapy on the importance of self-care and debunked whatever rumors were swirling at the time. I developed a mantra with everyone: “Wash your hands, wear a mask, get sleep. It’s just like the flu. We re all going to be fine.”
Of course I wasn’t so certain we’d be find, but I said it anyway.
On March 19, 2020 I conducted my last physical group session. Everyone was anxious but dealing well. We discussed the fact that group would likely be closing, maybe for a few weeks at most.
“When will we be able to come back?” One client asked.
“You can’t close,” another said. “I need this group.”
I reassured them we’d figure everything out. And so I did, setting the stage for a new telehealth counseling group though I had no concept how to create one.
The following week, at the governor’s behest, I began working from home. At first everyone — staff and clients — was inexperienced with telehealth. Few of the insurance companies my nonprofit deals with even pay for telehealth services. But we plunged in. Quickly picking a few accessible platforms such as Doxy.me and Zoom, we struggled our way through the learning curve. Technological roadblocks and inexperience plagued staff and clients alike, but we forged ahead. All the players reported feeling the same dominant emotion — anxiety.
I recommended that my clients take a media break. The information highway at the time was flooded with conflicting and anxiety-provoking information. I encouraged them to get their information only from the CDC website. This helped them focus and eased anxiety.
I worried a great deal about my clients. Though not impossible, it’s difficult to heal when isolated. We humans are social creatures. My last experience working under duress came after Hurricane Sandy struck New Jersey in 2012. A trend held true in both situations: People used to isolation, ether by choice or circumstance, were fine. Withdrawing from society even made some happy.
For others, though, sheltering in place was the first real isolation they’d ever experienced — and addiction is a disease of isolation. One woman I’ll call Susan was celebrating her second year of sobriety. Suddenly, she was unable to visit her elderly sponsor, her siblings, and even her own children because they worked in healthcare. She was told the quarantine was “for your own good.” But she shared that alone, without her family and supports, and with the fear of illness, she was isolated with her own inner demons again. They brought back the urge to drink stronger than ever.
And there were relapses, which did not surprise me or my colleagues. No one learns to ride a bicycle on the first attempt. Relapse is married to recovery. Without statistics, I will say relapse was higher during the early and middle stages of the pandemic. After self-help meetings and other support groups brought their services online, things shifted. People had a new way to be together. Anxiety gradually eased as people reconnected, engaged in active therapy, and shared with their peers. The workers who migrated services online are unsung heroes of this coronavirus event.
Simultaneously, telehealth brought new challenges, such as managing interruptions by children and homelife. Not all people have the luxury of privacy. One of my clients I’ll call Mary was isolated at home with her seven children, ages 2 to 17. While on the phone with me, she was rarely able to complete a single thought without being interrupted.
The deeper we went into the pandemic, the more fear, ongoing uncertainly, and grief over lost family and friends crept into sessions and groups. So did partisan politics. It’s difficult to create an atmosphere where clients can vent but not trample on other members with differing political viewpoints. Eventually, the routine of quarantine and isolation gave way to boredom and drudgery. Clients wanted to return to face-to-face sessions. So did I. Nuances, behavioral cues, and paralanguage are difficult to observe during telehealth. Losing them detracts from the clinical picture and interpersonal exchanges.
Through everything, though, my 30-plus clients endured. They innovated. They created. They asked for help. They helped each other. They became stronger.
I’ll remember the tenacity and resilience of both my clients and peers. We choose whether a crisis will define us or mobilize us into stronger people. Fortunately, I have witnessed the latter.
For more information on substance abuse therapy, click here or call NewBridge Services at (973) 316-9333.