Covid-19 Reflections VI

Reflections upon moving work online

Now, a few weeks in to these changes, there has been the time to mull them over. At the time there was almost none – seeing patients and supervisees in my consulting room until, on that Sunday evening in March, I found myself emailing them to say I was switching sessions online from the very next day.

How was I going to be able to protect the psychoanalytic nature of my work, for who knows how long, when some of its most fundamental preconditions were being disrupted, most of all the boundaries of my consulting room, which holds my practice? The closest similarity to the feelings stirred up for me were the feelings when I moved house, moving my practice and my consulting room at the same time – an experience that really brings home how much I rely upon the familiarity of my physical setting to contain me so that I can contain my work.

The exhaustion that I felt after the first week of the change was very powerful. I think it was partly because of the loss of the familiar ritual of the arrival in the psychic and physical space of the consulting room being replaced for me, as for so many others, with an uncertain roaming around the house with my laptop, in search of an adequate wifi connection in a room with guaranteed privacy for an hour or more (having now been able to settle back into my peaceful study, courtesy of a wifi booster, I feel quite a lot better).

The tiredness, also, was to do with recognising how much I rely on my nonverbal implicit embodied relationship with my patients - and how much my conscious mind has had to work overtime to compensate for the lack of this. The American analyst Todd Essig compares this working psychoanalytically online to driving in heavy fog: if you’re careful you can probably get where you want to go, but you will have to work so much harder straining your senses to pick up all the signals you would usually pick up without noticing: and you will most likely arrive at your destination exhausted.

In the first week especially, I was also very aware of a drift towards the more conscious and cognitive in the sessions, which seemed to be justified in part by the extraordinary circumstances – a time when asking someone how they are became so much more than a trivial courtesy, now saturated with new meaning and anxieties, and the impingement of the real, concrete world, that seemed to demand a real reply.

At the same time I have been fortunate in that my work has been on the whole grounded in established long term relationships with a depth of pre-existing knowing, and all have so far managed the transfer to online work. For some, such as supervisees who do agency work with a more chaotic caseload, it has been much harder. Some of my patients have moved to phone sessions, others to facetime or skype, some preferring face to face while others make eye contact at the beginning then lie down out of camera range for the session, resuming eye contact at the end. Some have reported feeling a deeper feeling of closeness lying there in their own safe space and enabled to connect at a deeper level. Without the presence of our bodies together in the room though, sometimes it can be more difficult to assess the quality of a silence, whether dissociated, reflective or tearful and anguished.

I think I have made more mistakes than usual, and there have certainly been more ruptures, both of the frame and the relationship in the moment. Yet at least so far none have seemed irreparable, and all have been part of a sometimes steep learning curve. People seem to be really appreciating and valuing each other’s willingness to stay in relationship; patients are bringing rich and interesting

dreams, we are still working in the transference. I am glad that, doing my best to stay open to the work and my own unconscious, I can still work.

 

Jane Polden is a Psychoanalytic Psychotherapist in private private practice.