The constraints of our external reality, imposed upon everyone, have required a change in the typical framework of my analytic work. A new practice, sessions held via telephone, unfamiliar but not totally unknown, was put in place. Surprises and questions associated with them are present during the session. In a general way, the effects of this novelty appeared immediately or over the course of the sessions, though I see few significant changes to the analytic process taking place for some.
For others, two configurations arose in the current experience, as illustrated by two short clinical vignettes. In addition to their uniqueness, they turn out to be the echo of this lived experience.
The ‘après-coup’ effect will likely make the outline of the configurations more complex.
For one patient, a radical change came about. Their associations are more fluid and their words flow more freely now. The physical and psychic presence of the analyst hinders and constrains their speech. The session is a source of arousal and conflict. Repetition, via transference, highlights the visual gravity of a paternal protective figure, envied and feared. The distance brings up some of the patient’s desires, speaking with her own voice, tied to being her father’s equal (free speech) and speaking just as loudly. Does this opening represent a profound rearrangement or an avoidance tactic? Perhaps a phobic symptom?
The online session creates a distortion of the framework. Metaphorically, the analyst’s office is partially ‘transported’ to the patient’s room or office, even though the phone call originates from within this movement. The physical act of holding the session is suppressed. What are, and will be, the psychic repercussions of this? Are narcissistic advantages not implicitly at work at that time?
Do they not persist as resistance during the in-person sessions?
From the beginning of this hybrid framework, without having really thought about it, I sat on my couch as I am accustomed to doing. Is it a necessary requirement to stay in the analyst's place? A place which, as we know, is never guaranteed once and for all?
Furthermore, I noted in passing the more frequent use of my first name at the beginning of the session, a shift towards a friendly conversation... The ‘refusal’ of all intersubjective communication in the flow of the session recreates the two asymmetrical psychic scenes. This familiarity disappeared as soon as we said goodbye. Is it not the sign of ‘strangeness’ for the analyst, confusing in this new form of work?
For another patient, this reversal of places, of spaces, brings about an opposite change, as described below: for him, the standard surety of his private space is no longer secure. He isn't able to speak freely about what comes to him. In moments of persecution, his fear of intrusion into the session by one of his family members has him ‘on alert’.
Edmundo Gomez Mango wrote that:
the analyst's place of work can become a home for the stranger who frequents it, without the possibility of it ever being their home. The analyst host is at home, but in a retreat that becomes their sole availability, a retreat which varies just as their renewable hospitality. While at home, the analyst remains a stranger who, without being able to embrace the privacy of others, is witness to it. [1]
This substitution of artificial stacking frameworks creates a confusion or bonding of the spaces that were previously separate, of the private and the foreign. Psychic privacy is subverted. The analyst host loses this characteristic of being a host. They are sometimes the auditory witness of physical actions of the patient (movement, various noises) as a transgression of the rule. Their free-flowing listening is interfered with.
‘Psyche’ (is) broadened, and thus becomes confined.
[1] E. Gomez Mango. L'intime pensée,
Nouvelle Revue de Psychanalyse n° 40 – automne 1989.
Translation: Benji Muskal