Are You Still There?

My patient, whom I'll call Emma, lies on the couch telling me about the shock of learning her mother had had a brief marriage in her twenties.

“She isn't who I thought she was.” Emma says. She coughs, clearing away her emotion. “This sounds crazy but it reminds me of when I found out there was no Santa Claus. I was so shocked. I felt tricked. Betrayed. Naive.”

Emma's voice trails off, her body still.

My mind wanders to how these feelings connect to her life, and to me; her words sparked all the familiar connections an analyst might make. Which of the myriad thoughts should I speak to?

Time passes. Seconds. Minutes.

Surprisingly, an image of my sister gleefully telling me, “there is no Santa Claus” pops into my head. Like Emma, I felt humiliated, naive, and betrayed.

Since working remotely, my internet sometimes disconnects without warning, leaving patients floating in virtual space.

Emma remains silent. Is she, too, lost in remembering?

It is then that I notice her utter stillness on the couch. My body clenches. My mind is hijacked by the sudden worry: Is she lost in thought or has my computer frozen? Should I ask, “Are you still there?”

Should I reboot my doxy.me?

With these questions, I am no longer in this moment of shock, sadness, and betrayal. No longer with the young woman who learned her mother had a secret or with that child who learned there is no Santa Claus.

I lean forward in my chair, trying to get a closer look. I stare intently at the top of her head, down the left line of her body, hoping to see some movement—a finger or foot tapping.

Please, move, I think anxiously.

Finally, I accept that the screen has frozen—nobody can lie that still!

Frustrated, I get ready to click on the words “Leave Meeting,” when Emma startles me and says, “My mother tried to…” She continues, unaware that she had briefly lost my attention.

Since working remotely, my internet sometimes disconnects without warning, leaving patients floating in virtual space. The fantasy of our being together in an “analytic space” is ruptured, reminding us that we are actually miles apart.

On this day, if we had been disconnected, Emma might have re-experienced something similar to what she had just been talking about—the betrayal and humiliation of talking to no one.

Yet I have grown accustomed to this new medium. I continue to listen, make connections, provide support, attend to our relationship, to the outside world, and to the past—in other words, all the ways I worked when in my office, before

Covid-19. And yes, most of the time, it goes pretty well.

Nonetheless, I cannot deny the losses accrued in the new virtual sessions. These include the multiple ways we receive information, often outside our awareness. The quiet that allows time for the mind to wander. The registering of bodily information. The subtle nuances of affect we apprehend in the physical presence of another.

In this session with Emma, I lost my state of receptivity, where ideas, associations, and memories enter. When some part of my attention was preoccupied, I could no longer wholly relax, silently gathering my thoughts and fantasies.

I miss the burst of inspiration and surprising imagery that rise to the surface when my mind wanders, when the unconscious of the analyst resonates with the unconscious of the patient.

Yet, even when both parties are in the consulting room, a state of reverie is difficult to achieve. There are always distractions, intrusions into the work, noises from outside the office and internal ones—thoughts and worries we each carry into the session. But in a virtual world, additional intrusions arise. Now, when we hear a faint clicking sound, we pause and listen more closely, anticipating the dreaded disconnection. The patient turns back and asks, “Are you still there?”

Similarly, the flatness of the screen does not allow for the intuitive registration of what is happening in the patient's body. The two-dimensional quality leaves us unable to feel or touch the material in the same way. We rely more on verbal communication, missing out on all the subtle—visual and somatic—cues we innately respond to the visceral ways of knowing. The way the body tenses up when afraid or emits certain smells, pheromones when excited, or the coordination of heart rhythms when two people are in a close, synchronous interaction. These are the currents, electricity, that pass back and forth between two people, outside their awareness, in the same room.

Yet we should not lose sight of how easily language allows us to conceal our thoughts. As therapists, we go beyond words to emotions and images of unformulated experience. This is especially important with early trauma—states of being that may never have been processed in words, or experiences that arise from the first years of life, when gestures and the body constituted our chief means of communication.

As analysts, we work hard to create a safe space, one that facilitates interpersonal and unconscious communication. And while remote therapy offers the opportunity to work in these difficult times, we should not overlook what might be lost, the rich and complicated world of affect, with all of its physicality.