My practice is pretty analytic, pretty classical. I have one patient with whom I’ve had phone sessions in the last three years somewhat consistently, because that patient finds it impossible to get to my office. But other than that, phone/Skype/Zoom sessions simply are not part of my practice. I historically have simply not conducted my practice using those modalities.
Further, my adherence to a classical frame is, generally, pretty complete. I start on time. I end on time. I don’t self-disclose much, if at all. I charge for missed sessions, for whatever reason, with whatever length notice (other than planned vacation). I don’t communicate about clinical matters via e-mail or text. Ever. And I see most of my patients two or more times a week.
All of that has pretty much survived the transition to Zoom. (All my patients have transitioned to Zoom – including those on the couch – except one, who prefers phone, and two who simply paused treatment.) I haven’t found much shift in the frame – other than the fundamental shift of modality.
What has changed substantially for me are two things:
1) Several patients have commented to me that I am much more “chatty,” that I talk much more during sessions. I’m paying close attention to this, and/but I’m not sure I have much of a conceptualization of why this might be.
2) I find my countertransference reactions to my patients heightened exponentially. I feel much more warmly to those patients I’m inclined to feel warmly toward; much less tolerant of those I’m inclined to find troublesome. In some instances, I’ve nearly snapped at patients with whom I’ve struggled with negative countertransference – particularly when they’ve either denied reality (like one who told me that he looked forward to seeing me next week in my office, again) or expressed particularly narcissistic, or narcissistically displaced anxiety. I like to think I’ve avoided actually snapping, but I’ve certainly not been my best clinical self. And in other instances, I’ve found myself almost consoling those to whom I feel more tenderly. And consoling is not a thing I typically do.
I have a colleague who feels uncomfortable accepting the same fees from her patients given what feels to her a “lesser” form of treatment; I’m not afflicted by this particular anxiety, because, if anything, I feel that even if the treatment is somehow “less,” it’s, at the same time, both more costly to me to provide, and more vitally important than our usual in-person sessions.
And here’s a thing I’m struggling with that I haven’t yet resolved: my schedule is effectively unchanged from what it was when I was seeing folks in the office. But that gives me both breaks during the day and time I previously spent commuting when, if I emerge from my little cave, I am likely to encounter one or both of my wife and son. Whom I love. But whom I’m often not in a psychic space to interact with moments after finishing a session. Even when I had a 35-minute commute, I often found that wasn’t enough space for me, and I relied on not just the commute, but also the first few sips of Scotch (Ardbeg An Oa, if I’m feeling peaty, or Oban, when not) and the attendant alcoholic softening to ease my transition into family space.
I’m not sure how I’ll resolve all this – whether I’ll rejigger my schedule a bit, so I have fewer breaks, or so my breaks include a transition time between when I finish a session and when I emerge from my cave. Or what. But it’s tough.
And add to that – as a patient, and as a patient in a four-day analysis, I am just now seeing how much a part of the session is my trip to and from my analyst’s office – the leaving of my office, the walking to hers, the entry to her building, riding the elevator, sitting in the waiting room, etc. And I’ve been advising my patients to be mindful about how they approach our sessions – at a minimum, that they ensure privacy and stillness and lack of distraction when we meet – and, more maximally, that they strive to mark the time somehow – whether by spending a period of time transitioning into and out of our sessions, or whatever else might work for them.
And, finally….
I’m finding opportunities like this, to connect with friends, colleagues, and peers, even more valuable than before. And those who know me know how much I already valued that. But I really value it now. I’ve been filling my schedule with peer supervision meetings, one-on-one catch-ups with friends and colleagues, and doing just about everything I can both to give myself the opportunity to think and talk about anything other than COVID – and, to think and talk about what it’s like to do what we all are doing right now, which is talking about COVID pretty much all the time.
