© Illustration by Chris MacDonald

For this conversation, I invited my aunt and uncle Diane Rostant and Michael Llach. Both are Licensed Marriage and Family Therapists (LMFTs) with nearly 30 years working in the field, 20 of those years working with the giant health provider, Kaiser Permanente. Living and working in one of the country’s most diverse and sizable communities, San Fernando Valley, California, they have heard it all. 

I wanted to learn how the global pandemic and current political environment were shaping psychotherapeutic practices and conversations. I could not stop imagining the realities of married therapists now executing their work from the comfort of their home. 

I quickly found out that what sounded like a brilliant plot for the next Yasmina Reza play, naturally didn’t last long.

Michael: “Well we worked together in the same house for about three days, and it was awkward. It was really bad. Two people in the house doing therapy in different rooms.”

I can imagine! So then what do your days look like? 

Diane: “I am working from home around 36 hours a week. I see about seven patients a day, back to back to back. And there aren’t any ‘no shows’ with the online structure, there are often some ‘no shows’ in person, so right now it is even more exhausting.” 

Michael: “I went back to the office, and I see my patients through the phone, video, and a handful of them in person. I am doing seven to nine sessions a day. And there’s a transition in therapy that’s occurred with this pandemic, in how people go to therapy, because therapy is now in their home. People present themselves much differently. I kinda like the ‘old way’ where people came to my office, they got ready to see Michael, presented themselves, and they showed up - ”

Diane: “They were dressed.” 

For context, it is important to picture the joyful spirits that are Michael and Diane. They are both former theatre practitioners, always smiling, joking, and laughing with and at each other. Our conversation was no different. 

Diane: “I have a hard time when I am working from home and Michael is home. I feel weird. I don’t want him to hear me, hear the session, because it is such an intimate, private thing. Even though it is Michael, having someone in the same house feels not right.” 

Michael: “When the pandemic first started, I was doing my sessions from home for about three or four weeks and just what you described was not good for me.”

I shared my realization regarding the power of a commute. Up until the pandemic, I was able to bike to and from the office, and didn’t realize until recently how much of a release that time served as. Being able to exhale work responsibilities before entering the comfort of my home was really instrumental for my mental sanity.  

Michael: “Yeah it’s like the patient’s juju was in the house and I did not like having those problems in my living space. I think it’s interesting– the idea of the commute–because for me it’s only about 15 minutes but they are 15 minutes I really look forward to. Crank up the stereo, Van Morrison my brain out and it creates a buffer.” 

Did you find anything that worked for you in those days that you were home?

Michael: “I just toughed it out. It really was just toughing it out. I was so unhappy having to do work in my house I realized.”

Diane: “It’s interesting, people are amazingly attune to how they are being attuned to. On the phone they can sense if you are not ‘there,’ completely present and that is the exhausting part of the job. You have to be totally one hundred percent with them, the second you veer off they know it.” 

Michael: “That is why you come home from work and just watch America’s Got Talent. It is not flexible for us, we are working harder than ever. This is the hardest I have worked in my whole career.” 

Roughly how many patients are you seeing a week? 

Michael: “About thirty five.” 

So your rolodex is a pretty consistent 100 patients a month floating in your active repertoire? 

Michael & Diane: “Yeah.”

Diane: “Some of my patients are currently waiting about three weeks (to see me).” 

Are you finding patients can still be as vulnerable and honest when they are now having their sessions from home? 

Michael: “I have noticed that one of the challenges in the new ways of working … those moments, on a given day, where normally there would be a number of times where something happens, where you know somebody got a little deeper insight about themselves, I find that it is happening less.”

Diane: “I have mixed feelings. At first during this pandemic, a lot of the anxious clients were doing great, they loved it. “They were like ‘I don’t have to go out’ ‘I don’t have to be in social situations.’ ‘This is the calmest I have ever been.’ Now they are getting anxious with it going back to normal. And then there is the other kind of client who is really having a rough time, I mean really having a rough time. Very anxious, more depressed.” 

Michael: “Anger, fear, and anxiety seem to be dominating.” 

Diane: “A lot of fear, but I have people who in a way are disclosing more which is interesting. Maybe because they feel safe in their own home, and not seeing me, just on the phone.”

I know it is mostly confidential, but can we speak roughly on the clients you are working with. How many of them are new, long-time, and/or seeking help as a result of the pandemic and everything taking place? 

Michael: “In a given week, I have about five new patients. I would say 50 percent over the course of a month are there because they are overwhelmed by COVID restrictions and pressures. There is another thing that has become more and more of a problem that the political environment in the United States has become a clinical problem.” 

Diane: “Huge. Anxiety, fear.”

Michael: “I have worked long enough to know that every election cycle is bad, but this time it has been continuous since 2016, and now it is reaching new levels. I have a good amount of conservatives on my caseload and they are as wound up as liberals are. I have had people talking about environmental stress, worried about that now too.” 

Diane: “Over and over I hear the word ‘uncertainty.’ People are having a really tough time, and they just want some certainty in their life.” 

And what is the advice there?

Diane: “I start with more behavioral day-to-day. You do have control over how your day is going to go. What would that look like for you to feel good? Getting out of bed, making your bed, going for a walk, simple things sometimes, but people just haven’t thought of it.” 

Michael: “I also push people to acknowledge where they have control. Just because they don’t have control over something doesn’t mean they should be unaware, but they should also not let themselves be defined by what they can’t control.” 

Diane: “This is all of course after first validating their feelings, acknowledging that what they are going through sucks. And then, encourage and help them to find the control.” 

Michael: “Yeah, help them see value in what they do.” 

I am currently trying to learn how to not take everything to heart, nor allow my energy to be absorbed by so many outlets. Living in a time of information overload, endless questions, fears, doubts, and aspirations, it is easy to get lost. How can one find clarity, are there clues we can pick up on that you use in your practice? 

Michael: “I spent a decade doing addiction work. I am quite familiar with the process, challenges, and facets relating to drugs and compulsions. Within that there are relationships impacted by a person’s behavior. (A hypothetical example) a woman right now who is teaching from home now (lots of teachers are struggling) and she is just home so much more. She comes (into my office) as a teacher stressed out as a result of COVID. She is finding herself feeling less capable as a teacher than she did in the classroom. And in exploring that in my direction of the dialogue, because that is really what a lot of therapy is, asking the questions to get them to the realization. So here she is at home, feeling insecure about her teaching all of a sudden, but really her husband is a bit of a drinker who likes his six pack or more every night, and he gets belligerent telling her ‘she is a dumbshit and lazy.’ So now she is teaching in a place where she is a ‘dumbshit and lazy.’ What was happening is that at work she felt free, but at home is locked into a codependent relationship. So for me, it was getting her to see that maybe she is carrying her home and marriage attitude in her teaching.” 

So most of the work is pinpointing the stress and source of the problem?

Michael: “I think it’s being able to say out loud what is in the back of their minds. It is not even that we say anything so profound it’s just saying something out loud and somebody else saying it to you.” 

Diane: “When I feel like my patient and I aren’t getting anywhere, I start asking questions more focused on their childhood and the roles and relationships in their childhood, that is when stuff becomes moments of ‘wow, ‘I see.’ Invariably, I swear, it always goes back, it’s just human. It’s weird when somebody  says it out loud, for a lot of people it gives them an ‘oh my god’ moment and then it gives them freedom to have more choice. ‘Do I want to react like this?’ ‘Let me look at my options,’ - it’s really, can we go back to the present?”

I like the concept of going back to the present. Therapy seems to always be projecting fears of the future or reflecting on the past. 

Diane: “Totally. Absolutely.” 

Trying to find presentness. I am sure that is why an hour of therapy is so valuable. 

Diane: “Yes and we try to bring them to the present through mindfulness, and breath, and it can be pretty powerful.” 

Is there advice for anyone to practice if they do not have the ability to seek professional help? 

Diane: “We do recommend people develop a routine. Writing can also be very helpful for people.” 

Michael: “Yeah positive psychology does a variation of a ‘gratitude list’ and at the end of the day rather than making a ‘to do’ list for tomorrow, end your day acknowledging what went right. It doesn’t have to be a whole journal, it can be simply a list, saying things like “I finally finished folding the laundry in the dryer, finished my taxes, and I had a conversation with my sister.” It has been found over and over again that one of the major curative factors for depression is being able to experience gratitude and demonstrate it in some way. Just doing that can be a tremendous help at an emotional level.” 

Diane: “You want to shift their focus, they are so focused on the negative.” 

Michael: “Also, I’d say upwards of 60 percent of new patients with depression and anxiety, if they just improve their exercise and sleep, the symptoms diminish and become instantly much more manageable. There are so many people sleeping six and a half hours and less.” 

Diane: “All of our patients, it is across the board.”

Michael: “People are working so hard, people are really struggling. So much on the mind just to get by.” 

Has the number of people with sleep anxiety increased?

Michael: “It’s gone up, definitely in the last five years. You know, I just read an article with a National Geographic study about the average sleep pattern in 1920, and the average sleep for an adult then was nine hours. And then the media came in, and all these distractions, and the sleep number has been diminishing ever since. It’s interesting.” 

I have one or two more questions, is that okay? 

Diane: “Sure, this has been fun! We talk about our patients together all day long, but we never talk about the process for ourselves.” 

Human psychological growth and evolution is a fascinating, endless conversation. I am curious to know if practice has evolved over the course of your career? Because fundamentally I feel that humans themselves have not changed much, the key feelings of depression, fear, jealousy, will never change.  

Diane: “It’s always the same. Love, heartbreak, togetherness, autonomy. But it never gets boring. It is always fascinating. Often we (as therapists) are just normalizing feelings like ‘who wouldn’t feel anxious right now?’ We try not to pathologize. A lot of times, in this society, people pathologize a lot. They want to snap on a diagnosis when it is just human.” 

I couldn’t agree more. I laugh about it because recently, my sister and I had a stretch of nights where if we would feel any remote sensation in our bodies that may be a symptom of COVID we would wake up in a deep sweat, mind semi-seriously made up that we have the virus. Even before this pandemic gripped us all, society has been obsessed with the instant diagnosing and pathologizing of anything. We have no patience with the unknown, nor with ourselves. We resort to labeling everything, and holding on to uncertain answers when the answer is simply that we are experiencing normal, human feelings. 

Diane: “Like with grief, people will feel like there is something wrong if they cry too much, or cry too long, or cry too little - and no, it’s just being a human being.” 

What is one thing you wish more people knew?

Diane: “I do wish people knew that everyone makes sense once you hear their story. The angry guy makes sense, the bitchy older woman makes sense, the “lost” person makes sense, the woman who sleeps with one guy then on to the next makes sense, and so on. And, you have some version of love for them all because you understand why they are who they are.”

Michael: “I wish more people knew and had confidence in their own internal goodness. In the course of my work, I have had heart to heart conversations with over 10,000 people, and of those there are maybe a half dozen who are bad people. You get to hear about them and you are able to tap into something fundamentally right and honest and they do not know it. I wish more people had greater faith in that part of themselves.” 

Diane: “I also wish more people knew how alike we all are. There is nothing more prominent in therapy and it could almost make me cry right now, but how much we all have in common. I am talking about the 90 year old and the 18 year old. There is basic human experience. We are all connected, we are, we really truly are. I met with a homeless woman the other day and I find I have stuff in common with her. We are all connected, we are really not so different. We are all struggling.”

–

By Chris MacDonald

Edited by Conor Golden

The Chico Club is a collective of reflections, ideas, and dialogues - shared with a purpose. The goal is to open our minds, hearts, and conversations, and embrace that we are all “still learning.”