"If This Is the Apocalypse, Should I Still Be in Therapy?"

Is there a point to working on long-term growth when the world is in chaos?

“I mean, should I still be trying to self-actualize?” my client clarified for me, “if it’s all going to end anyway?”

I pause, taking a minute to breathe before I deliver my response. “I think you know where I land on that debate, but the important question is, where do you?”

She asked me this question in a joking tone, inviting me to take it as such, but chose to take the question at face value. It’s a good question. When the rest of the world is thinking about economic collapse and infection and ventilators, can anyone be expected to strive for growth? Are we capable of moving forward in our minds when so much within our physical lives has stalled?

My client had stumbled upon an issue that lies at the heart of much debate within psychology. Maslow’s famous hierarchy of needs states that people can’t tend to higher-order psychological needs when their lower-order needs haven’t been met. At the simplest of levels, I agree with this perspective: A person dealing with food insecurity is not going to be able to effectively work on their attachment insecurity because their attention is focused on the more imminent threat. But as with many things in life, the devil is in the details. Anxiety makes us believe that we are always under threat, that things are always in a state of emergency. Human minds are masterful at finding danger, even when the news is not trumpeting a rising death toll. The trick to resilience is nevertheless finding a way to create a mindset wherein one can set aside the particular stressors of the moment to focus on those bigger-picture areas of growth that cut across situations. But how?

This difficult work of moving beyond the physical moment, of imagining a different reality than the one that actually exists, is exactly what we ask of many of our clients. Imagine the adolescent living in a neglectful home environment whom we ask to evaluate cognitive distortions or practice progressive muscle relaxation. How can this client engage in this work when their home life is full of comments that sting and silences that cut? Can they hold onto the feeling of security they get from therapy tightly enough to take a risk? Can those feelings protect them even when we aren’t there? We certainly hope so, for it is in that space that we are asking them to grow.

At its best, the therapeutic relationship is a refuge of security during times of threat, a source of felt safety that we hope our clients can carry with them during the 167 hours each week spent away from us, among the myriad dangers of the world outside our office (or outside our Zoom chat). In therapy, it’s as though we are laying down stones along a river bed for our clients to jump along to the other side. Only, in reality, we aren’t able to lay the stones all the way across the river bed, and the water in the river is quite rough and cold, such that several of the stones have washed away. Crossing the river bed on the stones requires a lot of trust, a great deal of courage, and the faith that what awaits them on the other side of the river tomorrow is worth the risk of stumbling in frigid water today.

And all of the sudden, I realized what my client needed from me. She had told me what it was right at the outset, but I had wanted her to articulate her own feelings (ambivalence, fear, or otherwise) about going to therapy during a pandemic. Now I realized that perhaps what she needed, what she was really asking, was Do you know where we are going? Did you remember to leave the stone for me? And, ultimately, Will you be here with me?

“I think this might be the most important way to spend your time right now. I mean, if the world’s going to end, let’s go out doing this together.”