Letters from Lockdown

Dear all,

In the Seattle suburbs (where I live), people stay at home, as in most cities in the world, except for outings for groceries, to the pharmacy, and for walks or biking on trails. My state (Washington State) has not officially declared a lockdown yet, even though there are many infected and many fatalities, especially among the elderly.

As many others have described, I initially consulted with my patients about the possibility of continuing their treatments remotely, but since last week, I started working exclusively by Skype, phone, FaceTime, and Zoom, and now I have learned about doxy.com.

At the beginning of the session, I direct the camera toward my face to greet my patient, as I would do in their physical presence, and I show my face again at the end of the session. But during the session, with the patients who use the couch, I direct the camera toward the window, so the patient sees the sky that they always see through the window of my office when lying on my couch, so their view is the same as when they are in the office. This way, I try to minimize as much as possible the enormous distance that exists between a face-to-face session and a forcibly remote one.

With some patients, the material that emerges is attached to external reality, but with others, remote sessions are very similar to in-the-room sessions, and the external reality is facilitating the emergence of forgotten or repressed material that is linked to their past experiences, personal history, and traumatic events. This terrible crisis has brought not only the least healthy regressions as some have described (patients in their pajamas, etc.), but also regressions in the service of making the unconscious conscious, recalling details of traumatic situations in their history, of war, traumatic memories of previous times in oppressive governments, and different types of losses. Others, on the other hand, show their denial of the situation. And still others have responded with panic and hopelessn