Practicing, Providing and Prevailing in a Suffering Economy

Over the past few months, you have no doubt received invitations to workshops or postings on professional list-servs about caring for yourself and your patients during these confusing and challenging financial times. How do we hold and provide for our patients as they experience job loss, dwindling resources and dashed plans for the future, while we, at the same time, watch our hard-earned savings circle the drain? How do we maintain our own steadiness when practice hours begin to shift and diminish? What will happen when we no longer have the means to take vacations and enjoy all the restorative activities that once helped us do our work? Must we relinquish fantasies of cutting back on patient hours to pursue life pleasures outside of our offices?

These stresses and tensions impact the therapeutic dyad in many complex ways. For several of my patients (many of whom work in financial services), this is the first time they have experienced an overwhelming disruption to their senses of themselves as solid providers for their families and communities. Realizing that they have helped to crush the financial dreams of other people, and that much public disparagement and derision is aimed at them, many experience unbearable feelings of guilt and shame. They also feel betrayed by an economic system in which they had placed their faith.

Treating patients who struggle with such devastating (often traumatic) blows to their self-esteem is now, for many of us, a big part of our work. We are called upon to provide a responsive surround in a time of war, religious extremism, unenlightened leadership and diminishing government resources. Our efforts at ongoing self-regulation in the face of all these dire circumstances are now further complicated by our threats to our own financial stability.

In sessions, I wonder how my realization that the economy has massively imploded in proportions unseen in 70 years might be influencing my therapeutic relationships. I worry about what will emerge, as I listen, with perhaps too much interest, to talk about "the markets." I feel waves of anxiety overtake me as I try to regulate my feelings of outrage about reckless and unfair governmental actions taken at our expense, at the uncertainty that infuses speculations about our nation's economic recovery. I find myself yearning for wise counsel from lost family members who in my fantasies would have certainly known what to do. Yet, now more than ever, I want to provide the selfobject support that my patients need so much. I want to open my therapeutic relationships to new ways of weathering the hard times.

Perhaps this clinical moment offers some clues to as yet untested possibilities. Right before the crash, a patient of mine left an established firm to start his own investment fund. Having thoroughly explored the meaning of this step, we both felt pleased and excited that he was moving forward in this way. He had let me know that my recognition and appreciation of his talents allowed him to tolerate the risks involved. As the downward spiral in the markets deepened, I frequently inquired about his anxiety since, under certain stresses, he had tended to shift away from reflection and toward reaction. During a session, my feelings of fear and despair about the declining economy were in the air as we discussed his investment philosophy about when to "hold 'em and when to fold 'em." Afterward, he very caringly assured me that if his thinking were to change on these matters, he would share his thoughts with me. My inquiry provided the grounding that he required in order to maintain his reflective posture. And, his recognition of my anxiety was very moving to me. It seemed to hold us in a way that said, "We are in this together; I have your back too."

I believe it is precisely this emotional tone--we are all in it together -- that will provide the strength we need to remain open and flexible through these uncertain economic times. And, it seems to me, that our country is already poised to make this shift---we seem to be set to provide, in myriad ways, for those who have been marginalized and forgotten. A wonderful example of this spirit was recently captured in a news story about a successful businessman who arranged to take a group of disenfranchised people who heretofore would never have had access, to the inauguration. He made plans for them to stay in a four star hotel, wear couture evening wear, sip Champagne and dance at the inaugural balls.

So, how can we move toward transforming our economic despair into hopeful possibility? One way, I believe, is to think about the larger system, that is, the community. We might consider looking outside our consulting rooms for opportunities to demonstrate our humanity, to lean in and be part of this emerging paradigm of mutual caring. There are returning vets who need, not only drugs, but our trauma skills; inner city kids who need an arm around their shoulder; and too many unemployed who no longer feel vital, creative and productive who can benefit from our skills, too. Like the businessman who treated others to the inauguration, it's time to show our boldness and willingness to go over the top in a new direction.

Susanne Weil is a graduate of The Training and Research Institute for Self Psychology (TRISP) in New York City. She is a faculty member at TRISP and at the Westchester Center for The Study of Psychoanalysis and Psychotherapy. She is in private practice in Stamford, Connecticut.