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Back in 2020 when clinicians mourned the empty couch and adjusted to working remotely, most had at least been physically present with their patients to that point. During the past couple of years, many of us have had to begin work with patients having never even met in the flesh, so I would like to thank the anonymous clinician who shares below something of their experience of moving ‘from Zoom to the room’. Much is still emerging about these changes to the frame, for example, what happens to the developing transference when there are only part-objects on a Zoom screen, both parties unknown to each other below the head and shoulders, literally reduced to ‘talking heads’ like the BBC television series from the writer Alan Bennett 30 years ago. Our three commentators bring contrasting responses; one compares the patient's defences to a citadel and the therapeutic encounter as an ‘adventure’, another uses the neuropsychoanalytic approach, and a third focuses our thinking on the somatic and forthcoming ending.
Despite the challenges, all commentators sense a real connection that develops over time. Perhaps it is also worth noting here that I had never met in person the clinician whose clinical material has been so generously offered, that is, until our final meeting, and looking back I think this is when the material really became ‘alive’.
Katya Orrell
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(The clinical material has been carefully disguised to preserve the patient's anonymity.)
Pauline is a young woman, referred for depression and anxiety, whom I saw for once-weekly, time-limited psychotherapy in the public sector. As therapy began during the first wave of the pandemic, establishing the setting was particularly relevant. The only way to deliver psychotherapy was by phone or videocall until it became possible to provide the final phase of treatment in the room.