When I was first invited to share my experience of working psychoanalytically in the time of Covid-19, I had two thoughts, each of which seemed equally certain to me: first, I thought that I had a great deal to say and that I could not contain myself within the limits of any reasonable presentation. And then, immediately, it occurred to me that I had nothing at all to say and my only honest response would be a blank stare or an empty page.
On reflection, it seems to me that both of these accurately describe my state of mind.
There is a great deal to say because I am flooded with impressions, impressions that come from working with my patients when both of our lives have changed so suddenly and so dramatically and when the conditions of our meeting have gone through a profound upheaval. New impressions strike me every day, earlier ones fade, many change on almost an hour to hour basis. Describing them feels like trying to put words to what I see in a kaleidoscope; I can't quite catch up with my experience.
But, equally, there is nothing to say, at least as a psychoanalyst, because what I have always thought of as my professional function – making meaning or at least being a guide to making meaning – has been significantly compromised by the very circumstances I am trying to understand. For now, at least, we have lost our bearings and we have lost our roadmap; to claim otherwise strikes me as little more than a conceit. Yet we must and we do keep working, and a vital aspect of our work is sharing impressions that resist formulation and that will not be theorized for a long time to come.
The first thing I noticed when I stopped meeting with patients in person is that in light of the dramatic change not only in the psychoanalytic frame but in our life circumstances, I felt a need, shared by me and my patients, to locate each other psychologically and even physically. I only do phone sessions, a choice I made on the basis of personal preference. I find the phone less technically mediated than platforms that offer visual content, and it offers the added benefit to me of providing a privacy I find conducive to reverie and to thinking generally. None of my patients have objected.
But this means patients cannot see me, which may increase their concerns about my health and safety. Many of them do believe (correctly, because of my age) that I am more vulnerable than they are; and many begin sessions by asking “How are you?” And at least at the beginning of the pandemic I felt I had to, and wanted to answer directly. I stress that I wanted to answer the question directly to make sure I don't imply that I see this simply as a necessary modification of technique —i.e., that I answer rather than wondering about the meaning of the question either openly or silently — mandated by the changed analytic frame. I answer because it feels (to me) reassuring to both my patient and myself that the two of us constitute a stable unit in the midst of tumultuous times.
From the vast array of impressions that has shaped my experience of working during that pandemic I will pick one; I have been particularly struck by a paradox that has arisen, inchoate and largely unarticulated, from the flow of impressions. I will try to put this into words.
As I work and live through the pandemic, I find myself experiencing a heightened awareness of both shared experience and dramatic inequality. Both of these reflect the reality in which we are embedded; it occurs to me that we could certainly say this about our work at any time but that many of us tend not to. It is probably to our benefit that we are forced by the pandemic to address these themes directly; I am referring to aspects of reality that precede the attribution of personal meanings that shape our experience.
It is clear now, as it rarely has been, that on the one hand we are immersed in a common trauma, in ways that are unique or nearly unique to our present circumstances. I am thinking not only of the threat to our health and safety, or even to the disruptions in our daily routine. At least equally important, we are embedded in the same uncertainty. Very concretely, I have no idea of when — or how — I will get back to my office and I wonder, as I am sure we all do, about whether my practice will ever return to what it has been like for decades. What will I want it to be like, and what will my
Jay Greenberg, Ph.D., is training and supervising analyst at the William Alanson White Institute; editor of The Psychoanalytic Quarterly; and recipient of the 2015 Mary S. Sigourney Award
patients want it to be like? On a larger scale, I don't know whether psychoanalysis will ever be the same.
These questions – some of which can be thought about, some of which cannot, some of which can enter the analytic conversation, some of which can't or at least don't – certainly reconfigure the analytic field. But this is where I want to leave things at the level of impressions and not conceptualizations or even meanings, because I don't have any idea what the effect is. All I know is that both analyst and analysand are changed by what has happened and by what is continuing to happen.
…both analyst and analysand are changed by what has happened and by what is continuing to happen.
But on the other side of the paradox is the inequality; my circumstances and those of my patients (and of many colleagues as well) differ, often dramatically. I do find my days surprisingly exhausting, an experience that has been reported by many colleagues, but the work is interesting and I am not suffering financially. I am able to shelter in a place I love, and I have spent most of the pandemic, so far, with some of the people I love the most. Some, but far from all of my patients are as fortunate as I am. But many, who are younger than I, are isolated, cut off from social and professional opportunities that are developing and they hope will shape and define their lives. Others, older and approaching the end of their careers or even their lives, are facing the possibility that everything is coming to an end they have been anticipating but don't yet feel prepared to face.
And, of course, I am talking about an inequality that exists at the uppermost margins of privilege. We practice in a world that is dominated by the horrific politics that afflict many countries, and we continue to do our work while covid wreaks its havoc disproportionately on people of color. We analyze as the murders of George Floyd, Breonna Taylor, Rayshard Brooks, Ahmaud Arbery, and so many other Black citizens shine a glaring spotlight on the terrors that are the product of enduring racial injustice in the United States. We analyze as hundreds of thousands of Americans wait for countless hours on food lines. All this drives home to analysts, analysands, and analytic dyads that we are unspeakably fortunate to be able to work together as we do. This cannot be at the forefront of our awareness at any moment, but it must have a profound if often unarticulated effect on what happens in our sessions.
It is worth mentioning, in one respect at least, our circumstances are not unique; pandemics have always been far harder on the less privileged. Consider this description of an earlier plague:
Some people, pursuing what was possibly the safer alternative, callously maintained that there was no better or more efficacious remedy against a plague than to run away from it. Swayed by this argument, and sparing no thought for anyone but themselves, large numbers of men and women abandoned their city, their homes, their relatives, their estates and their belongings, and headed for the countryside….
The passage is from Boccaccio's Decameron, written in the 14th century and set in the time of the plague that ravaged Florence. Reading this while sheltered in my own house in the countryside triggered, as you can imagine, a range of feelings that invade virtually every session.
The upshot — and let me reiterate I am describing impressions and not conclusions — is that feelings about the trauma we are living through together, about unequally distributed vulnerability, about shared but not quite shared privilege, about guilt about what I have and envy of what I don't have flood every moment of every session. Necessarily and fortunately, these feelings are largely unconscious and I am able to catch glimmers of them only retrospectively.
But recently, several months into the pandemic, I have noticed, perhaps because of the swirl of feelings I've been describing, that I am more shaken than I usually am by some of my countertransference experiences, even when I have some sense of what has triggered them. In retrospect (although I caution that what counts as “retrospect” changes every day), it occurs to me my reaction to patients asking “How are you?” is an example of this. Being asked by concerned patients to reassure them I am well reminds me of my own concerns, and my own concerns as well as the patient's enter into and shape the analytic field.
All this drives home how, even in the midst of shared trauma, there is an irreducible otherness that is an essential characteristic of every analytic — and human — dyad. We psychoanalysts (rightly for the most part) tend to pride ourselves on our empathy, but we disavow otherness and the feelings that are stirred by it at our peril. We will, I suspect, learn a great deal about how this illuminates the work we are doing and have always done. But we will, I am sure, learn it only après coup.