Before the pandemic, I survived tough work weeks by having something to look forward to — a dinner with friends, going to the movies, or even a trip in the future. As an extrovert, I decompress with people, but with quarantine, work from home, and plans outside of my house on hold, people were no longer an option.
Trying to cope alone, I felt off of my axis. "I'm tired," I would say repeatedly to my therapist. "Just exhausted." Even as a psychiatrist who deals with emotions and words all day, I struggled to describe my experience.
With the help of my therapist, I was able to define it: I was lonely.
Loneliness is described as the subjective experience of our social relationships when there is a gap in quantity and quality between the relationships we hope to have, and those that we actually have. In other words, it is possible to be around people and have a lot of friends, and be lonely, and also, to be alone without feeling lonely.
And I am definitely not the only one experiencing this problem. Loneliness was a significant issue even before the pandemic; a 2018 Kaiser Family Foundation study found that 1 in 5 Americans said they always or often felt lonely or isolated. Unsurprisingly, the circumstances of the pandemic only worsened things, impacting our overall mental health and wellbeing. In my practice, my patients regularly bring up similar feelings as a major source of their low mood.
After naming my problem, I joked with my therapist that she was my only consistent relationship. I mean, I "saw" her weekly over the computer, and because she was there, I always had someone to talk to, even in the hardest weeks.
Still, she was not (and will never be) a replacement for socializing and friends. Having a therapist in the first place is a privilege and absolutely helps with coping with loneliness, but to put it plainly, my therapist is not my friend.
That is why I was baffled when I read this semi-viral tweet: "People using psychs and therapists dramatically increased with the decline in community. Finding belonging, understanding, and answers, and love by outsourcing your agency to a professional is not it."
Of course, it isn't "it", because it was never supposed to be. Having a therapist by no means replaced my (or my patients') need for social support. Sure, for those who don't have social support or a safe community, therapists might serve more of that role in the interim and that is absolutely necessary and significant. But it is an entirely different relationship than those we have with our friends, even if it is an important one.
First of all, the relationship between therapist and client/patient is inherently unbalanced. Patients talk about themselves much more than even the most self-disclosing therapists talk about themselves. For the therapeutic relationship to work, it has to focus on the patient and their needs, which is much easier to do when you don't know as much about your therapist and they aren't taking up space in the conversation.
Imagine having a friend that you knew nothing about, but they knew your deepest, darkest secrets... Friendship is a two-way street. Therapy is not."
—jessi gold, m.d.
Therapists are also pretty much contractually obligated to be neutral about everything you discuss. Instead of making you feel bad or judged for a decision, they help you understand the situation better and your reaction to it. None of this could work in a friendship. Imagine having a friend that you knew nothing about, but they knew your deepest, darkest secrets. Or, one where you could constantly mess up and the person simply helped you understand why, without their feelings involved. Friendship is a two-way street. Therapy is not.
Your therapist also has more power inherently in their role. You might call them by their last name, which creates formality, but you also pay them for their work. It is their job to help you, and, as such, this alters the dynamic. Strict boundaries are part of the treatment, like not talking outside of the office, not accepting social media requests, and not texting. For people with difficulty setting boundaries in their lives, the therapeutic relationship can help model how. But, if this was a friend, a person would constantly feel like they were much more into them than vice versa. Again, this wouldn't work. If your relationship with your therapist feels just like your friendships, it also might be time to consider asking your friends more about themselves. Vulnerability is nice in friendships, and it brings you closer together, but it is much better when both of you are vulnerable and the support is equal.
This doesn't mean that therapists have no feelings toward their patients. It just means our reactions and feelings are compartmentalized. Otherwise as an empath, every time a patient feels, I would, too. And, after hours and hours of a lot of feelings in appointments, I'd burn out. Some emotional distance is self-protective.
Plus, it is hard to be a neutral, objective observer with people who are closest to us and objectivity is important in therapy. It is why therapists are ethically not allowed to treat their friends and family. The "dual role" clouds our judgment with feelings and opinions and that can interfere with treatment, making therapy less effective and even causing harm.
Therapists have specific skills and knowledge that most of our friends don't have, and frankly, shouldn't be responsible for having."
—jessi gold, m.d.
At the end of the day, the job of the therapist is to help your mental health, something a lot of us need two years into a pandemic. Therapists have specific skills and knowledge that most of our friends don't have, and frankly, shouldn't be responsible for having. Having a therapist helps take the burden off of friendships and can help protect them by providing a separate outlet for you to turn to for support.
There are also goals to therapy, including no longer needing therapy, and not in friendship. While a therapist doesn't replace community, they can help you learn to find it, understand the value of it, and be more comfortable connecting with it. In other words, therapists bolster community support, they don't replace it.
Still, while my therapist isn't my friend — and I never expected her to create belonging, understanding, and love — she is critically important in my life and to my wellbeing. And, contrary to what this hot-take on Twitter may claim, therapy is not outsourcing agency, either. It is a way to strengthen it. There is no shame in needing or wanting professional help, ever.
Don't get me wrong, I like my therapist and part of why she is good and I feel supported by her, is because I could be friends with her and at times even want to be. But, I am not and know I can't. The therapeutic relationship is hugely important and so is friendship. Loneliness can be tackled with both.