The Virtual Year in Psychotherapy and Psychoanalysis
By Dr. Rochelle Broder
This has been the year of remote psychotherapy and psychoanalysis. Yes, psychoanalysis, too: patients in repose on a couch, in their homes, and not seeing me on the screen, enabling less social referencing and deeper intrapsychic associations.
Though immediacy and closeness are lost by not being in the same room—alas, there are interruptions by unstable Wi-Fi, freezing screens and dropped connections--individual’s internal conflicts still emerge. One woman is doing her sessions in her son’s old bedroom—a favorite child who she compares to me and feels closer to me while in his room. A new patient cannot find a place for himself without feeling someone will intrude, so moves from space to space in his home; his first meeting with me was in a closet. I learn that he has not felt he has space in his mind for his needs, always adjusting himself to others and feels emotionally unsettled.
When the session opens for another man, my screen is filled up by the face of his chocolate labrador licking her chops. The patient lives alone and “shows” me the closeness with his dog, although he has a difficult time showing his connection to me after eight years. I’ve also found that some patients actually open up more because of the virtual distance. Some intense feelings can feel too real, raw or shameful in person.
When I started video sessions in March a year ago, my first session was with a patient who was holding the laptop right next to her face. It filled up the screen and I was so startled. Who is ever nose-to-nose in the room? When on the phone with a patient, it can feel super-close; they are right in my ear and my head. And who ever looks at themselves when they’re having a conversation in real life? That little self-view is distracting.
The good news is my patients are benefiting and getting better. There are both losses and opportunities for growth in this mode of therapy. Some people love this mode (I wonder if they like remaining a bit distant), and some can’t stand it and want to breathe the same air as me.
Even though I’m seven minutes from my office, there is no getting around the convenience of working from home. I get to share more meals with my husband, and we’re able to attend more to our elderly dog.
I’ve thought about how I’ll continue working when in-person sessions are safe. Now that I’ve accessed the flexibility of virtual sessions, I can use it if in-person sessions are difficult, like on a “snow day” when driving is treacherous.
For now, I can’t imagine the dust that’s accumulated in my office this past year.
Rochelle M. Broder, Ph.D., a native Detroiter, is a psychologist and psychoanalyst in private practice in Royal Oak, Michigan. She is a high school friend of the editor, Andrea Sachs.