Psychotherapy Intervention to Overcome the Difficulty of the “Possibility of Coexistence” Manifested by the COVID-19 Pandemic

This study aimed to examine how individual-level problems faced by children with vulnerable sense of self interacted with social-level problems during the COVID-19 pandemic, focusing on the difficulty of achieving coexistence. The clinical material presents interactions with a 10-year-old boy who was not attending school and displayed violent behavior. In addition, he faced challenges regarding the intergenerational transmission of the theme concerning what has been prevalent in the family culture. The outbreak of the COVID-19 pandemic led to an increase in anxiety and fear at the societal level, presence of different variants of viruses, and difficulties in coexisting with others. Individual-level problems of coexistence, which were difficult to address in regular psychotherapy, became more complex owing to the overlapping effects of social-level problems. The therapist faced the difficulty of working with the countertransference of two mixed emotional experiences: the infection caused by an invisible virus and the infection of primitive emotions in the child’s infantile part through projective identification. In working on this countertransference, it was important for the therapist to hold on to his own experiences of coexistence to maintain his function as a therapist. Furthermore, the search for how the therapist and child could coexist in psychotherapy led to a “consensus process,” leading to an equal relationship. Based on such internal work of the therapist and the “consensus process,” the child’s vulnerable boundaries were modified, and an adequate multilayered boundary became established, which generated the “possibility of coexistence.”