A morning with Belize
I wake up and open the shutters. The morning is full of sunlight. For a moment, I stand still and allow the light to enter the room, touching familiar objects, announcing another day. Then I go to spend the first hours of the morning with Belize, my horse.
Belize is blind in her right eye and has partial vision in her left. Over time, I have begun to notice that she encounters me differently depending on where I approach her from. My presence is not the same to her from every direction. Sometimes I sense that she has seen me, or registered my movement, before I have fully understood what she is responding to. At other times, I realise that my approach has placed me somewhere within her world that requires a different kind of attention from both of us.
I am learning that meeting Belize means learning how to approach her. It means becoming aware of where I stand, how I move, and what she might be able to perceive from her particular position. I cannot take for granted that my presence is experienced in the way I intend it to be. I have to remain attentive to the difference between what I think I am communicating and what may actually reach her.
There are moments when she seems to want to be behind me. She comes close, follows my movement, and offers me something I can only describe as her embodied trust. I feel the weight of her presence, the quiet responsibility of being the one who moves ahead. There is something profoundly intimate in this arrangement: she cannot see the world as I see it, yet she is willing, in that moment, to move with me.
At other times, the relationship changes. Belize seems to notice something that I have not noticed. I become more attentive, more careful. The animal I might have imagined myself guiding becomes, in some sense, the one who invites me to pay attention. I begin to wonder what she has perceived that has escaped me.
I do not know exactly what happens within her. I can only attend to her movements, her responses and the changing quality of our contact. Perhaps part of the beauty of our relationship lies precisely in this not knowing.
She does not encounter me from a neutral position. She encounters me through the possibilities and limitations of her own perception. And I encounter her through mine. Between us, contact is continually being negotiated.
Sometimes I lead; sometimes I follow. Sometimes she seems to place herself in my care; sometimes I feel that I am being asked to trust her awareness of a world I have not fully registered. Neither of us has the complete picture.
I have begun to recognise something of my own experience in these moments. Living with Long COVID has changed the way I inhabit my body and approach the world. There are days when my own capacities are uncertain, when I cannot rely on the familiar relationship between intention and action. I have had to learn that what I can do, what I can perceive and what I can offer may change, sometimes without warning.
I do not confuse my illness with Belize's visual impairment. Her experience is hers, and mine is mine. Yet being with her has helped me understand something about the humility required to meet another being whose world is not entirely accessible to me.
Perhaps this is what I am learning from her: that contact does not depend on two beings seeing the same world. It depends on their willingness to discover how they can meet within the worlds they actually inhabit.
And I wonder whether something similar happens in the therapeutic room.
Entering the room with my own body
I enter the therapeutic room not only as a psychotherapist, but also as a man living with Long COVID. My illness accompanies me, even when I do not speak about it. It is present in my understanding of fatigue, in my awareness of how much effort an apparently simple activity can require, and in my knowledge that what is visible from the outside may bear little resemblance to what is happening within.
When a young person tells me that they can no longer do what they used to do, that their body has become unpredictable, or that they no longer recognise themselves, I listen with my professional knowledge and with something that has entered my understanding through experience.
Yet I must remain aware that my experience does not make me identical to the person sitting opposite me. Familiarity may bring me closer, but it can also tempt me to assume too much.
I think of Belize. I may intend to approach her gently, but my intention alone does not determine how my approach is experienced. I have to pay attention to her response. In the same way, I may believe that I understand a client's suffering, but I cannot know whether my words have reached them until I attend to what happens between us.
In Gestalt therapy, contact emerges at the boundary between self and other, between the person and the world. We do not meet from nowhere. We meet through our bodies, histories, expectations, vulnerabilities and particular ways of perceiving. The relationship itself becomes a place where these differences can be encountered.
Sometimes, as therapists, we are tempted to believe that empathy means entering another person's experience. But perhaps empathy requires something more delicate: approaching closely enough to be affected, while remaining aware that the other person's world can never be entirely ours.
When the body becomes unfamiliar
Long COVID can disturb the quiet trust through which we inhabit our bodies. Fatigue, cognitive difficulties, pain, sensory disturbances and post-exertional symptom exacerbation may appear in different combinations and fluctuate over time. Symptoms can persist, change or return when we thought we were improving.
The difficulty lies not only in their multiplicity, but in their unpredictability. We may wake feeling hopeful and discover that the day will demand more than we can give. We may manage an activity one afternoon and find ourselves unable to repeat it the next. The body no longer offers the same assurances.
For me, one of the most difficult aspects of this experience is that I cannot always make sense of what is happening. I may recognise a sensation without understanding its cause, or notice a change without knowing what it means for the hours ahead. The body, which should be the most intimate part of myself, can become strangely unfamiliar.
The wound is not only physical. It can become existential and relational: a disturbance in our relationship with ourselves, followed by a growing difficulty in finding our place among others. We may no longer recognise ourselves in the lives we are living, while those around us continue to see the person we used to be.
For adolescents and young adults, this can be especially painful. These are years in which identities are forming and the future is beginning to open. Friendships, education, intimacy, independence and the discovery of one's place in the world may all be affected by an illness that is difficult to predict and difficult to explain.
The young person may ask, “Why can't I do what everyone else can do?” Beneath the question there may be another, more intimate one: “Why can't I be myself anymore?”
In the therapeutic room, I want to make space for this question without hurrying towards an answer. I want to help the young person rediscover a relationship with their body that is not based entirely on monitoring, fear or disappointment. This does not mean asking them to trust a body that has become unpredictable. It means allowing trust, if it becomes possible, to develop differently and at its own pace.
The words that do not quite reach us
We speak of fatigue, brain fog, pain and Long COVID. These words are necessary. They allow us to communicate symptoms, seek medical help and make an experience legible to others. Yet sometimes the word arrives where understanding should begin, and the conversation stops.
When I say that I am fatigued, what does another person imagine? Ordinary tiredness after a long day? The need for rest, a good night's sleep, a little time away from one's responsibilities?
The word may be understood while the experience remains unseen.
Language can become a form of desensitisation. A complex, intimate and shifting reality is compressed into a familiar expression. Once the symptom has been named, others may feel that they know what it means. But the word fatigue cannot convey the calculations that precede a shower, the fear of having to cancel a meeting, or the sadness of discovering that there is not enough energy for both an ordinary task and a moment of pleasure.
A diagnosis may describe something real without conveying what it means to live inside that reality. In this way, a person can be medically recognised and still feel existentially unseen.
I think of how I approach Belize. Knowing that she has impaired vision is important, but it does not tell me how she experiences my presence from a particular direction. I have to attend to the encounter itself, to what changes when I move, when I wait, when I allow her to approach me.
Perhaps listening to a person with Long COVID requires a similar attentiveness. Instead of assuming that the word fatigue tells me everything, I might ask, “What happens to you when the exhaustion comes?” or “What becomes difficult at that moment?”
These questions return language to the living body. They invite the person to describe not simply a symptom, but the world that symptom creates around them.
The shame of not understanding ourselves
There is a particular vulnerability in not being able to explain one's own body.
When symptoms fluctuate, we may begin to question our perceptions. Yesterday we managed to meet a friend; today we cannot manage a conversation. We may wonder whether we are exaggerating, whether we should try harder, or whether our limitations reveal some personal failure.
The uncertainty of the illness becomes uncertainty about the self.
Shame often enters quietly. We apologise for cancelling plans. We feel embarrassed when we need to rest while others continue with their day. We hide our difficulties because we do not want to appear weak, unreliable or demanding. Gradually, we may begin to judge ourselves through the eyes of a world that expects consistency, productivity and visible signs of illness.
For young people, this can be particularly painful. They may see their peers moving forward while they struggle to maintain a familiar rhythm of life. They may conceal their limitations, even from those who love them, because they fear becoming a burden or being seen as someone who is no longer able to participate.
In my own experience, I recognise how difficult it can be when the body no longer behaves in ways that make sense to me. There is frustration in not knowing what tomorrow will allow, but there can also be shame in having to admit that I do not know.
When a client expresses similar feelings, I try to listen for the judgement hidden within their words. Beneath “I couldn't go” there may be “I let everyone down.” Beneath “I need to rest” there may be “I am not doing enough.” Beneath “I don't understand what is happening” there may be the fear that they can no longer trust themselves.
Psychotherapy cannot remove the physical reality of the illness through a change in attitude. But it can help distinguish the body's limitations from the shame that has become attached to them.
A person who needs to rest has not failed. A young person who cannot participate as before is not less worthy of friendship. And not understanding every symptom is not evidence of weakness.
Perhaps the first movement towards self-acceptance is not learning to love the body as it is, but allowing oneself to stop treating it as an adversary.
When our vulnerabilities meet
There are moments when a client speaks and I feel an immediate recognition. Perhaps they describe the loneliness of appearing well while struggling privately, or the frustration of having to abandon something they had looked forward to. I notice a tightening in my chest, a memory of my own experience, a wish to reassure them that they are not alone. My first impulse might be to say, “I understand.” But I pause. Do I understand, or do I recognise something in myself? Am I responding to the person before me, or to a part of my own story that has suddenly become present? I might instead say, “It sounds as though you have had to explain yourself so many times that even explaining has become exhausting.” Then I wait.
Perhaps the client begins to speak about friends who no longer ask questions, parents who believe they are improving because they look better, or the shame of repeatedly having to justify their limitations. Perhaps something else emerges that I could not have anticipated.
Nothing has been resolved. Yet the client may no longer have to work so hard to make their experience acceptable to another person.
This is where I find a particular resonance with Gestalt therapy. Contact requires both connection and difference. I can recognise something of myself in another person while remaining aware that their experience is not mine. I can be moved without taking over. I can allow my own vulnerability to deepen my listening without asking the client to care for it.
If I disclose that I also live with Long COVID, the decision must serve the therapeutic relationship. My experience should not become the centre of the room, nor should it be used as proof that I understand. I might say, when appropriate, “I know something about living with Long COVID myself, but I know your experience is your own. I would like to understand what it has been like for you.”
I return to the image of Belize sometimes wanting to move behind me, trusting me to take the lead, and at other times drawing my attention to something I have not seen. I cannot assume that I will always be the one who knows the way. Nor can I abandon the responsibility of guiding when guidance is needed.
In the therapeutic relationship, too, there are moments when I offer steadiness and moments when a client's experience reveals something I had not considered. This does not reverse our professional responsibilities, but it reminds me that the encounter is alive. I am not a detached observer of another person's world. I am a participant in a relationship that asks me to remain responsive.
Learning another rhythm
Long COVID can make the ordinary rhythms of life difficult to sustain. Plans become provisional; participation requires calculation; the future can no longer be assumed. For young people, the pressure to return to their former lives may come from parents, friends, educational institutions and from within themselves.
In psychotherapy, we can unintentionally repeat this pressure if we measure progress only by increased activity or a return to previous functioning.
Yet post-exertional symptom exacerbation can follow physical, cognitive or emotional effort, sometimes after a delay. Encouraging a person to push through their limits may worsen their symptoms. Psychological support must respect the physical realities of the illness and complement appropriate medical care.
From a Gestalt perspective, creative adjustment is not about overcoming every limitation. It is about discovering how to respond to the conditions of one's actual life. Sometimes this means changing expectations, asking for help, reducing demands or finding another way of participating.
The question may gradually change from How can I become the person I was before? to How can I remain in contact with what matters to me, within the life that is possible now?
There is no simple answer, and the question may need to be asked repeatedly. A young person may learn to cancel a plan without calling themselves a failure, to tell a friend what they need, or to recognise that resting is not the same as giving up.
I think of my mornings with Belize. We do not need to make the world entirely predictable before we can inhabit it together. We develop familiarity through attention, through repeated encounters, through learning when to approach and when to wait. This does not remove uncertainty, but it changes how we live within it.
Perhaps something similar becomes possible in the therapeutic relationship: not mastery over what cannot be controlled, but a more compassionate way of meeting what is here.
Remaining with what we cannot know
Long COVID confronts patients, clinicians and researchers with uncertainty. Symptoms may change over time, and the course of illness can be difficult to predict. In the therapeutic room, this can create a temptation to offer reassurance, find an explanation or move towards hope before the person is ready.
I recognise this temptation in myself. As a psychotherapist, I want to help. As someone living with Long COVID, I know how painful uncertainty can be. I may wish to offer the words I would have wanted to hear on my own difficult days.
But perhaps the most respectful response is sometimes to resist the urge to resolve the moment.
A young person may need to speak again about the same fear, the same loss, the same uncertainty about whether life will ever feel familiar again. This repetition need not be a failure to move forward. It may be part of the effort to live with an experience that has disrupted the stories through which the person once understood themselves.
I do not want to write the next chapter for them. I want to help keep open the space in which they might eventually discover it for themselves.
Belize does not need me to know precisely how she experiences the world. She needs me to be attentive to her responses, to approach her with care and to remain willing to learn from our encounters.
Perhaps the therapeutic task is not so different. We cannot enter another person's experience completely, but we can approach it with enough humility and tenderness that the person no longer has to face it entirely alone.
Conclusion: The possibility of contact
Living with Long COVID has changed the way I understand my body, my work and the fragile relationship between the two. It has made me more attentive to the exhaustion that words cannot fully describe, to the shame that can grow around unexplained symptoms, and to the loneliness of inhabiting a reality that others may only partially see.
It has also made me more aware of the limits of my understanding. My experience can bring me closer to a client's suffering, but it cannot replace the work of discovering what that suffering means to them.
For adolescents and young adults, whose identities and futures are still unfolding, this distinction matters deeply. They need a place where they do not have to prove their illness, hide their contradictions or pretend to know what the future holds. They need to be met as people whose lives remain larger than their symptoms.
I began these reflections with Belize, in the sunlight of an ordinary morning. She reminds me that the world can be encountered in ways I cannot fully know, and that attention may be more important than certainty. She teaches me to slow down, to listen beyond appearances and to recognise that contact begins not with the assumption that I understand, but with the willingness to discover.
Perhaps this is also the heart of psychotherapy with people living with Long COVID. Not to explain another person's body to them, not to hurry them towards acceptance, and not to promise a future we cannot guarantee. Rather, to accompany them as they learn to inhabit a changed world, while remaining attentive to what still brings them into contact with life.
Some mornings, the sun enters through the shutters and the day opens before me. I go to Belize, and we find our way into the hours together. I do not know exactly how she experiences the world. She does not need to experience it as I do for us to share a moment of trust.
Sometimes I lead; sometimes I follow. Sometimes I offer her a sense of safety; sometimes she reminds me to see what I have missed.
Perhaps, in the therapeutic room, we can offer something of the same possibility: a meeting in which uncertainty remains, difference is respected, and neither person has to become fully understood before contact can take place.
Sometimes, that is where the loneliness begins to loosen its hold. Not because the illness has disappeared, or because the future has become clear, but because, for a moment, we are no longer alone in the world we are trying to inhabit.
References
Frank, A. W. (1995). The wounded storyteller: Body, illness, and ethics. University of Chicago Press.
Kureishi, H. (2024). Shattered. Hamish Hamilton.
Newlands, F., Lewis, C., d'Oelsnitz, A., et al. (2024). “People don't have the answers”: A qualitative exploration of the experiences of young people with Long COVID. Clinical Child Psychology and Psychiatry, 29(3), 783–798. https://doi.org/10.1177/
Perls, F. S., Hefferline, R. F., & Goodman, P. (1951). Gestalt therapy: Excitement and growth in the human personality. Julian Press.
Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103. https://doi.org/10.1037/
World Health Organization. Clinical management of COVID-19: Living guideline. https://www.who.int/teams/