What happens when psychoanalysis moves onto Zoom?
Dr Stephen Blumenthal normally takes a moment to gather his thoughts before inviting patients onto the blue leather couch in his consulting room in central London. Each consultation begins in the same way as it would have done a century ago when Sigmund Freud developed psychoanalysis. Patients are asked to say whatever comes into their heads. Blumenthal’s job is to listen and try to interpret what else may be going on in there, in what is referred to as the unconscious mind – ideas or thought processes that the individual may not even be aware of.
Now the couch lies empty. Since London locked down to stem the spread of covid-19 Blumenthal has turned to teletherapy, as many other psychotherapists have, tuning into the minds and dream-worlds of patients via Skype and Zoom. Video calling has changed the dynamic between analyst and patient. “There is an ever-present loss of what once was,” says Blumenthal, 53, who works both for the NHS and in private practice. “You were once two people in a room together. You can never reclaim this through technology.”
The new medium is forcing Freudians to rethink principles they once held to be fundamental. Freud reckoned that analysis should be conducted in a neutral setting that revealed as little information about the analyst as possible, a blank canvas onto which the patient could project their unconscious thoughts. As a result, consulting rooms have tended to be furnished simply with few adornments.
Teletherapy makes that impossible. The analyst has no control over the patient’s environment on a video call, and can’t stop them being interrupted. Some patients have been retreating to their cars to guarantee them peace and quiet, says Blumenthal. Analysts too may have to allow patients a window into their own domestic lives. “At first it felt like an intrusion,” says Blumenthal. “My view now is that if you reveal nothing, the patient senses defensiveness and it can inhibit them.”
When I call Blumenthal on Zoom he crackles into life in a small, white-walled office, wearing a black Lycra sports shirt. Immediately I wonder if he has been cycling – perhaps this is his favourite hobby. A blue rug is draped over the back of his chair – my mind leaps to what it might be covering up. These thoughts are what Freudians would consider an example of transference, the strong feelings or assumptions that the patient “projects” onto the analyst, and would be harnessed in therapy to make sense of my internal world. According to Freud, transference reveals much about what is going on in the patient’s unconscious. Analysts are still working out whether you can pick up such feelings on a video call.
In normal psychoanalysis consultations, what is not said can be just as important as what is. “Words are an inadequate medium with which to access the unconscious,” says Blumenthal. “We listen between them to the silences.” Silence in cyberspace has a different effect. When a person falls silent on a video call, it can be harder to sense their presence. The analyst may feel prompted to speak more and interfere with the patient’s flow of thought and speech. Other vital non-verbal cues – itching, the crossing of legs – can be more difficult, even impossible, to spot via teletherapy.
There can also be unexpected advantages to the new medium, says Blumenthal. On the day that we spoke, he told me that he’d been forced to interrupt a teletherapy session on Zoom earlier that day in order to answer the persistent ringing of his doorbell. He left his microphone on while speaking to the courier, who had a package for his son. When Blumenthal returned to the screen, his patient told him that he now knew he was a father – something Blumenthal had declined to confirm in a previous session. “The patient later told me that this made me more, not less, credible as his psychoanalyst,” says Blumenthal. “He found it moving as he realised he was dealing with someone who was also struggling to manage the upheavals of lockdown.”
ONE PATIENT CONFESSED THAT DURING APPOINTMENTS HE IMAGINED HIMSELF IN AN ATTIC ROOM IN HIS HOUSE. NOW HE COULD ACTUALLY SPEAK FROM THERE
Another of Blumenthal’s patients, who tended to be distant in face-to-face sessions, has become unusually effusive over the telephone, sharing intimate thoughts and feelings in a way he hadn’t managed to in the consulting room. He confessed that during conventional appointments he had often retreated to a place in his mind, imagining himself cocooned in an attic room in his house. During telephone therapy, he has been speaking to Blumenthal from this very room and finally felt able to allow his analyst into this place both physically and emotionally.
Freud was not averse to innovation. He famously invited a patient he nicknamed the “Rat Man”, because of his obsessive thoughts about rats, to dine in his consulting room. But most of Freud’s devotees have treated his strictures as gospel and followed them like a religion. Some dared stray from the path: Sandor Ferenczi, a close contemporary of Freud, practised “self-disclosure” (telling patients about his own life); Jacques Lacan ended sessions at moments of emotional significance rather than after the usual 50 minutes. Freudians dismissed such experiments as wild or dangerous.
Such a rigid approach has made it hard to try new therapeutic methods or treat particular conditions. Some patients struggle to follow strict schedules and meet at the same time every week; others find it easier to open up when they’re behind a screen than in person. So the changes necessitated by the pandemic could pave the way for more experimentation in the future. “It wasn’t so long ago that most analysts would dismiss the idea of teletherapy entirely,” says Blumenthal. “But within a week or two almost everybody adapted.”
The advent of teletherapy may make analysis easier to access, less time consuming (you don’t need to travel to appointments) and could allow patients to choose an analyst from anywhere in the world. Such change may be timely: Blumenthal and his colleagues expect both the period of being locked down and the pandemic to set off a tsunami of psychological illnesses. The Office of National Statistics in Britain collates monthly data on the number of people over the age of 16 reporting deep levels of concern and stress: the figure doubled between late 2019 and April 2020. In other countries there has been a rise in the number of people reporting anxiety or making calls to mental-health helplines.
Blumenthal has seen patterns of pathology emerge over the course of the pandemic. For people who are lonely and isolated, lockdown has caused mental anguish; for those with intimacy problems, claustrophobia. Job losses have damaged (particularly male) self-esteem and women have suffered most from the increased burden of child care and housework caused by school closures. Both sexes are likely to suffer continued anxiety about health and finance. Almost three months of enforced confinement have taken their toll on relationships.
The pandemic has also required therapists to view the behaviour of their regular patients differently. At first the abnormal suddenly became normal, says Blumenthal: “The initial phase of covid-19 turned psychopathology on its head. Many people showed signs of hypochondriasis, ocd, paranoia and depression – while those who had those symptoms anyway felt normalised.”
Now, a new phase of lockdown is changing the context again. Those who found comfort in isolation are feeling a renewed pressure to perform against the backdrop of an uncertain economy. “Now lockdown has partially lifted, more reclusive patients are reverting back to being psychologically unwell,” says Blumenthal. “At first, they gained safety and security from lockdown. Now they are returning to abnormality.”
Emerging from lockdown may yet prove to be the most mentally challenging period of all. Blumenthal refers me to the opening of T.S. Eliot’s “The Waste Land” – words which seem to capture the state of mind as our confinement loosens: “April is the cruellest month, breeding/Lilacs out of the dead land, mixing/Memory and desire, stirring/Dull roots with spring rain.” For Blumenthal, spring – the season in which suicides tend to spike – is also a metaphor for the feelings of fear that accompany periods of transition. “It’s that moment when you look out of your window and see other people going about their lives.”•
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Fuente/ Source: www.1843magazine.com
Por/ By: Sharon Hendry is a freelance journalist in London
Foto/ Photo: ILLUSTRATIONS MATTHEW RICHARDSON
PAGINA 100 POPAYAN COLOMBIA
PAGINA 100 POPAYAN COLOMBIA