The end of 2019 seems an age away, as it was the last time I was together with my family. In January, my daughter, with my two-year-old grand-daughter, were about to emigrate to New Zealand, which is her partner’s country of origin. This was going to be a great loss for me but they were to be near to her partner’s own family. They called themselves ‘internationalists’, as they frequently travelled the world and cheerfully chatted that we were to visit each other regularly. They had said to each other that using online communication would be just as good as visiting but I did not feel too convinced by this. However, talking online became the only means of communication for over two years, as visiting would never happen, due to COVID.

In February 2020, amid the first talk of pandemic, I was unwell with what I later decided must be the COVID virus. I could not eat, lost taste and smell, but seemed to recover after only a week. However, three weeks later I was again unwell with, what I later discovered, was long COVID. Suddenly, I could barely move due to the inflammation in my lower back and the pain in my joints. It was as if I had been in some kind of accident and there was continual exhaustion. When, after three months, this seemed to improve, I accepted a temporary part-time job as a systemic family psychotherapist at a local hospital for adolescent mental health. That summer there was no general testing, we did not know much about how the virus was spread, or if there could be reinfection after having had the virus. People closed windows in small crowded spaces where NHS professionals worked. No one knew that asymptomatic people could transmit the infection and many of us went out to eat together again. However, I was not able to see any of my family for over a year. My older son was shielding his mother- in-law and also his terminally ill father (who had cancer), and my younger son was in shared accommodation at the other end of the country. Although I was used to living alone, I began to realise that I had not managed isolation well and it was a relief to be in a job with people contact. New Zealand really seemed as far away as the moon.

In September, just as the job finished, I began coughing, the severe fatigue, bone, muscle and nerve pain of long COVID, returned and I lost hearing in one ear. This continued over the following year, with little sign of improvement, until eventually, after a third vaccination in November 2021, a very slow recovery began, with constant relapses. The pain was less severe and energy increased after two years of a struggle to survive, as I continued to work part-time in my systemic therapy private practice, and also to walk my dogs every day. These two parts of my life continued to sustain me as I struggled to exercise both my mind and body, and I knew from my therapy training that I had to work on both. Living alone in lockdowns meant there was no one to care for my energetic dogs if I could not. Also, along with other systemic psychotherapists, I had to find innovative ways of working online.

What is possible now for systemic practice?

At the beginning of 2020, I had hated the idea of doing therapy online. For a systemic psychotherapist this seemed to exclude all possibility of what I had come to think of as the “performance” that developed between ourselves and the client(s). The ‘magic’ of the non-manualised exchange, emerging from an intuitive response to a word, the awareness of a breath or a look, located in the physical presence of a body (Andersen, 1991). Systemic means the whole experience of living. The stimulation of the physical encounter feeds spontaneity, creating a dynamism that produces freshness and new ideas. Surely being online would destroy systemic therapy as we knew it. Yet this was not my experience. I was finding that COVID had given us new opportunities and that it was for each therapist to explore these different possibilities as ‘lone’ scientists. Perhaps, if I shared my experiences of the online process itself, with my client, then I would not be not alone, as we experimented with new ways of interacting.

A new virtual COVID world

As most psychotherapists, I am energised through helping others, and during the COVID lockdowns, there has never been a greater need of help, for so many people’s mental health. As many therapists moved to working online they reported the intensity of the virtual experience. This was increased due to the COVID isolation effect which seemed to be behind every therapeutic encounter. Couple stories of controlling behaviour seemed even more prevalent than before so I felt more needed than ever. What a great way to take one’s mind away from looking inwards! The brain fog disappeared when I focused on the lives of those others, as my mind framed systemic questions of curiosity about what I could both hear and see, virtually. Far from online work being the end of therapy as we knew it, I now had an astonishing new opportunity to see further into these other worlds. I ‘entered’ clients’ living rooms and saw the significant objects surrounding the daily life of couples at war with each other. There were now more clues as to the meaning of the distance between each of us. Even more useful, was finding that I was listening profoundly to all of the words that were said and the pauses between them (Shotter, 1993). I worked harder to question meanings and watched more closely the smaller but more focused images on the screen. There seemed to be new kinds of connections between us all that had their own magnetic power. Somehow the couple ‘dance’ was more evident as they each talked more freely, on their separate devices and in their different rooms. We were all more physically apart, but strangely drawn more closely together. I was now entranced by online zoom sessions with couples.

COVID has no sense of humour

Many clients had relationship crises as they struggled being with their partner every hour of the day. They never relaxed as online home-working took over both day and evening. Children seemed to be there and not there, but present in the background. Online therapy was more accessible for parents, but they were constantly working. I wondered how we could all try less hard to do better. It seemed that it was not possible to laugh, or joke, as in ‘real’ life. I thought about my training at South Wales University where my tutor, Billy Hardy, had told me that a sense of humour could be so helpful. As I reflected on the seriousness of living in a pandemic, I wondered if I could change the way I felt about this experience, towards a new appreciation of my existence in the world. Could I accept my own situation, using the differences to generate new understandings, not only about therapy, but also about this experience of unwellness? I listened to systemic online webinars of encouragement, (Bertrando, 2011, 2020), and wondered what he meant when he said that being in the present was even more difficult during a pandemic. I remembered hearing Tom Andersen at a KCC workshop in 1996, where he also talked about being in ‘the now’ and how action is embedded in the moment. I noticed I could slow down the pace online, to focus in on the client meaning, to share the potential moments for change.

Wanting to be heard and seen in the world

I had gained something new from COVID, experiencing and embracing a new found stillness. My other tutor in training, Jeff Faris, had noticed that I survived by ‘running’ faster than everyone else, like aircraft fighter John Boyd (Osinga, 2007). At that time, I had no idea what this meant. Now I that I could not physically run, I remembered the words and wondered, in the present, if I now needed to discover a different way of communicating.

While my systemic practice grew stronger, I did not feel as effective in the wider world and I also wondered if the online world was all that would remain. I became aware of feeling ‘othered’ by long COVID and frustrated by the initial lack of professional interest in the condition. GPs had little time for my symptoms as they locked themselves up in their own fortresses and said they could do nothing to help. Besides, I was doing everything I needed to do to. My dogs got me up in the morning and made me walk. When my oxygen levels dipped even lower than 70, and then increased to 95 again, I was not taken seriously and was told there must be some mistake. The long COVID clinic was talked about but this does not, in reality, exist in some areas of the country and at first physiotherapists in the UK were still using the graded exercise approach, which does not work with the group of people who were non hospitalised. However, the one to two million people with what was now officially recognised as long COVID provided a base for interesting research studies and some scientists were recording the strange symptoms to help understand the condition.

In June 2021, I was invited to be part of Imperial College London’s ‘React’ study into long COVID and at that time I still had over 20 persistent symptoms, many of which I had not previously disclosed. I think participating in this was a therapeutic act and a way of being ‘heard’. It was also a useful to track a reduction in the severity of some of the symptoms, which I might not have appreciated due to the fatigue itself. It was also important to feed back to the researchers that the vaccinations were linked to improvement. Also participating in the ‘Zoe’ Study (2020) of long-COVID patients, which has regular online live webinars updating us on recent research, allowed us all to contribute and to read each other’s responses. This was an important lifeline during 2021 and it was important to see and hear that I was not alone in the struggle to understand this unpredictable illness. Now, in 2022, like most people who have been unwell for a long time, I have begun to improve. Some people with continuous symptoms are looking for a medical cure and others advocate diet changes. It is not clear what the evidence is for particular approaches but perhaps this is all part of different, individual survival strategies. Just as many of the symptoms can vary, so does the search for new cures.

Long COVID affects everyone in society

A much greater focus on recovery for individuals could benefit society as half a million people of age 50 have dropped out of the workforce and are not seeking work. The reason for this is not known but could be due to long-COVID illness. There are many people who are absent from work, possibly also due to long COVID. We also do not know how people are managing to restore their health or how many remain partly unwell. It is unknown how much improvement in health is due to the individual journey people have been on and I wonder how many have used therapy to get help to manage the situation. It has been suggested that long COVID is psycho/social or biological in origin and there are more React studies focusing on this. However, it may not be possible to separate out some of these effects and at the moment there is a danger of increasing stigma, with individuals being even more reluctant to disclose their unwellness. Evidence from the React study that vaccination has helped recovery from long COVID gives support for continuing the vaccination programme more widely yet the promised UK spring vaccinations have been sparse and seem to have been focused on large cities. There are still stories of people at high risk who have not been offered these booster vaccinations yet. The initial hope to vaccinate the whole world has turned out to be more complicated than many anticipated and this is not surprising, given the difficulty the NHS had imposing mandatory vaccination on its workers. As greater splits emerge within society, there are questions about how we make good decisions for the benefit of all. If it is not possible to do this, do we need to learn different strategies for survival?

The hope is that we have learnt more

As many people began to understand more about how science works, it was clear that equality of opportunity for health would benefit all, but now this seems to have been forgotten. The results of the React research studies do not seem to have got through to the media which helps to inform general understanding, which in turn helps to affect policy making. The strong push to return to ‘normality’ may be too soon if we ignore the rest of the unvaccinated world. New Zealand has just opened up again after abandoning its battle to remain apart, but having won the fight to have the smallest death rate. Two of my children are planning flights across the world and no doubt this will improve personal mental health. My other child is talking about moving to an eco-friendly house. The COVID experience has been an eye opener but the divisions within society have increased. There are also many who are now more aware of the fragility of all life on this fragile planet. As COVID has been a wake-up call for the physical and mental health of humanity, it has also shown us that we are able to do things differently in order to preserve the world and ourselves.

Performing wellness for survival

I have observed a growing gap between those who have no fear and those who have fear. There are many who want everything to continue in the same way as it was but there are also those who look with different eyes. I wonder if there is a way for all of us to be more open and responsive to the moment, in both a personal and a collective way. Personal survival has now been experienced as connected to the survival of others and we have seen that the wellness of the individual depends on the wellness of the whole environment. My own experience of long COVID has given me a profound appreciation of the strength that can be discovered personally in suffering, but it is now time to relearn wellness. The act, or performance, of wellness ay now create different connections with others and a healthier environment.

At this moment, as many clients want to return to ‘in- person’ sessions, I wonder if it is also time to change strategies. I thought again of John Boyd whose ideas led to the OODA loop theory (observation, orientation, decision, action), in which survival hinges on the ability to make appropriate and fast decisions in accord with the environment (Osinga, 2007). An ability to survive, while continuing to observe and to interact well with others, is successful adaptation. Seeing clients both ‘virtually’ and ‘in person’ may be another step into what feels like a different world, but I hope that all these recent experiences will sustain me as they continue to inform A long-COVID survivor experience and systemic psychotherapy my systemic psychotherapy practice.

References

Andersen, T. (ed.) (1991) The Reflecting Team: Dialogues and Dialogues about the Dialogues. New York: Norton.
Andersen, T. (1996) Reflecting processes: Inner and outer voices including – ways of being with a client, four kinds of knowing, connections between stillness and movement, thought and action. Workshop at Kensington Consultation Centre. 1 November. Bertrando, P. (2011) A theory of clinical practice: The cognitive and the narrative. Journal of Family Therapy, 33: 153-167.

Bertrando, P. (2020) Reflections on his path in family therapy and systemic practice. Episode 2, systemic family therapists: on reflection, interview with Paolo Bertrando. YouTube Systemic Family Therapy Channel 3 June.
Imperial College London (2020) Real-time Assessment of Community Transmission (React) Study [online]. Available at: https://www.imperial. ac.uk/medicine/research-and-impact/groups/react-study/ [Accessed 23/08/22].
Osinga, F. (2007) Science, Strategy and War: The Strategic Theory of John Boyd. Abingdon, UK: Routledge.
Shotter, J. (1993) Conversational Realities. Constructing Life through Language. London: Sage.
ZOE Limited (2021) The ZOE Health Study [online] Available at: https:// health-study.joinzoe.com/ [Accessed 23/08/22].