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It can be easy to forget how shocking it was in March 2020 not to be able to see our patients. The task at first seemed to be a salvaging operation, finding a way to keep in contact and sustain some containment for our patients, our colleagues and ourselves. Gradually, we became more used to new ways of working, doing therapy online or by telephone, meeting patients outside, or working in person while wearing PPE.
What kind of therapeutic work can be done remotely? How different has it been from working in the therapy room? What have been the costs and have there been benefits? What has surprised us?
Ehud Wolpe, a child and adolescent psychoanalyst in Israel, describes how the key tasks he undertook developed over the course of the pandemic, from efforts to preserve the therapist’s presence in the child’s psyche, towards maintaining continuity and therapeutic presence and holding a new, unfamiliar type of transference with new mediators – the screen or the mask. Wolpe found that he could maintain a holding therapeutic environment, but at the expense of more in-depth analytic work. Gillian Sloan Donachy, in the UK, was reminded of what had been lost in remote working when she was able to take some walks with a patient in their final sessions.
Michael Garcia and Amanda Hutchison, in the United States, both managed to establish some continuity between working in person and online. Hutchison leaned into the technical glitches that bedevil our online sessions, paying attention to their emotional meaning and using them as a window on the transference and countertransference. Garcia is highly aware of what is lost in an online session, but emphasises that the therapist’s ability to think through experience can be sustained through remote working and that this is what is essential in what we do.
Online therapy is not a disembodied process. We are present in our own spaces, as are our patients in theirs. Carolyn Hart, a British child psychotherapist, found that working online ca