In March, as covid became a real and looming threat to the healthcare infrastructure, the leadership team at the Boston Psychoanalytic Society (BPSI) heard from members who wanted to volunteer to help the broader community, beyond the steady one-on-one work they do with their caseloads. But the membership was unsure how to interface with people in acute need, and how to leverage our uniquely psychoanalytic skillset: building a therapeutic relationship, and managing anxiety and trauma through discussion and insight, rather than through medication and behavioral exercises. In the past, BPSI has been characterized as slow-moving and risk-averse, mostly because of its large size. Not in this case: Having spent a week preparing a specialized referral email listserv, we had 30 volunteer clinicians signed up within four hours of announcing our program, and 60 within days. We invited two other psychoanalytic institutes in Boston – Massachusetts Institute of Psychoanalysis and the Psychoanalytic Institute of New England East— to join our endeavor, and they immediately and enthusiastically offered their members' help.
Boston has an extensive academic hospital network that under normal circumstances is secure in its ability to handle even the most complex illnesses; yet, we began hearing from our medical colleagues that they were deeply worried about the upcoming wave of patients and the way their employees would handle so much exposure to severe illness and death. Our vision became to support frontline hospital workers, nurses, doctors, respiratory therapists, as well as the maintenance employees who clean rooms— any workers in the medical establishment and their family members whose lives were affected by the demands of the pandemic.
We had substantial collective anxiety around whether our member clinicians could handle acute trauma presentations, and whether hospital administrators would partner with a psychoanalytic organization. While we had some successful outreach with psychiatry departments, many area hospitals were more “biologically oriented,” so to them, “psychotherapy” meant CBT, and psychoanalysis was something taught in undergraduate philosophy classes.
What a felicitous opportunity it turned out to be to reach out to 12 hospital systems. Department of psychiatry chairs who managed their employees' mental health needs expressed gratitude, and, in some instances, surprise that psychoanalysts have real world clinical capabilities. We were delighted to see clinical hospital administrators at our partner hospitals quickly agree to work with us. In some cases the department leaders had participated in and benefited from BPSI's education programs years earlier, including one doctor who attended our one-year fellowship training. (We've found that, despite the outlay in effort and direct costs, our outreach creates friends of psychoanalysis who then act as positive brand ambassadors for us at their own institutions.)
Here are the nuts and bolts of how the BPSI Responders Listserv worked: Our program used an email listserv in which hospital EAP or psychiatry departments were asked, after screening out such emergent presentations as acutely suicidal patients, to post a description of employee clinical needs, which are then emailed to the pool of volunteers. Hospitals then chose the best fit from the volunteers who replied. In order to reassure hospital departments, volunteers certified licensure, malpractice coverage, and good ethical standing.
To keep the referral process as friction-free as possible, we stipulated that volunteers agree to pro bono treatment once a week for up to three months; after that, they could negotiate continued treatment. In an attempt to offer a robust treatment process, we also stipulated that all cases picked up by volunteers, no matter how briefly, be considered full doctor/patient or psychotherapist/patient relationships, that is, each volunteer “owned” the patient as they would any person whom they started with in their practice. While we knew other volunteer efforts had set up more “crisis-line” single blocks of time for the public to sign up for, we determined our members' skills would be more effectively used were an ongoing relationship to be available. Hospital EAP systems could usually handle a single encounter, but we intuited that some employees would want a short-term therapy process.
It became clear our volunteer clinicians needed support as they took on clinical work that they were less familiar with. We organized Zoom drop-in trainings specifically on treating trauma, and upped our number of Zoom drop-in peer support groups, which had already been put in place to help BPSI members deal with the upheaval caused by covid and the move from their in-person practice to working virtually.
Daniel Mollod, M.D., is president of the Boston Psychoanalytic Society and Institute, a clinical instructor of psychiatry (part-time) at Harvard Medical School, and consulting staff, at Beth Israel Deaconess Medical Center. His private practice is in Brookline, Massachusetts.
Psychiatry department heads felt universally supported by the responders program. Just knowing there was a robust cadre of well-trained psychotherapists available reduced the distress of department leaders and their administrative counterparts. Able to be less worried that their department resources would be overwhelmed and depleted, they asked us to remain available as they anticipated that some hospital workers who might be holding back in crisis mode would later reach out for help once there seemed more emotional space to reflect on and process their experiences. Volunteers were able to help a wide range of hospital employees, from ER doctors, to PT's, to the worried children of employees.
Our outreach into the community yielded several surprising insights about psychoanalytic clinicians responding to crisis:
Psychoanalysts and psychoanalytic psychotherapists are enthusiastic about providing service to the community, but they need to feel supported and part of a group. This contradicts the stereotypical image of the psychoanalytic clinician in the silo of his or her office. Psychoanalytic clinicians without specialized backgrounds in trauma or PTSD can be trained in basic approaches to engaging and working with acutely traumatized individuals. Our clinicians reported feeling helpful and invigorated by such volunteer involvement.
Psychoanalysts and psychodynamic therapists bring a unique contribution to establishing a psychotherapy process. Many hospital departments have EAP services that provide only a limited set of interventions, but not treatment in the deeper, more holistic approach we bring. Skilled listening, empathy, and containment were among our most valuable psychoanalytic tools in the setting of covid.
Unless we actively engage hospital systems, psychiatry departments typically maintain outdated conceptions of what psychoanalysts and psychodynamic psychotherapists do. Despite what occasionally felt like an awkward first date, we have been able, through these efforts, to dispel negative stereotypes of psychoanalysis and psychoanalytic clinicians, and educate influential members of hospital systems and hospital psychiatry departments.
The covid era has ushered in, along with illness and death, a lot of psychological pain, discord, tragedy, and distress. To add insult to injury, the inequities and damage of systemic racism have become starkly and dramatically evident through the disproportionate suffering and hardship borne by people of color. I would like to think that one small antidote to the pain and divides of this era is the renewed sense of interconnectedness and generosity I see in small and ongoing ways in both the psychoanalytic and larger communities. We psychoanalysts have expertise and dedication to give, far beyond the usual safe confines of our consulting rooms.