For Some Psychotherapists, the Work Has Always Been Virtual

A therapist shares knowledge gained from two decades of teaching online.

  • Familiarity with the experience of online therapy can help ameliorate stress, both on therapists and our patients.
  • Online learning opportunities abound for mental health professionals, particularly in this era.
  • The ongoing stressors of the pandemic will affect individuals, couples, and families differently.

It has been a difficult year for patients and psychotherapists everywhere. As all therapeutic work moved online, my colleagues at the International Psychotherapy Institute and I had one advantage: We have been at a distance-learning institution for 25 years. As a result, we were ready when suddenly everything was forced onto online platforms. In particular, we were prepared to treat couples and families negatively affected by lockdowns, and to help our students do the same.

Even as vaccines offer a light at the end of the tunnel, online therapy and training are not going away. Here’s what I think therapists can learn from our experience:

Online therapy is better than ever. Our initial close partnership with the Tavistock Clinic, the Tavistock Institute for Marital Studies (now called Tavistock Relationships), and Westminster College in Salt Lake City, Utah, used early shaky technology and unreliable internet to establish distance training. At first, all of our students had to be in the same room at one of four locations; that was all the platforms would support. Over time, we adapted to each iteration of improving technology, and eventually we could reach people on their own computers, beginning about 15 years ago. We have now been conducting online trainings and supervision in China and Russia for a decade, even as the technology has continued to improve dramatically.

Opportunities for online training have grown enormously in the pandemic. A real paradox, for us, is that our training programs have grown enormously. Through offering Town Hall meetings and online trainings, we have colleagues and students joining us at IPI from around the world in much larger numbers, and despite the time zone differences. The need to put all our conferences online has meant that people could come to courses and conferences without the expensive need to travel. I do miss seeing my friends and colleagues at in-person conferences, which IPI has always held four or five times a year. But I am reaching and interacting with more people from all over – throughout the U.S. and Canada, India, Pakistan, Europe, the Americas, Australia and New Zealand, China, Romania, and Russia. For some in India, China, and Australia, our programs happen in the middle of the night, but still they come.

Online therapy allows for international insight: you’re not alone, and neither are your patients. Because I work with therapists worldwide, especially in China and Russia, I could see how much the pandemic affected couples and families everywhere, not just in the United States. Some were positively affected when they had more time together, and solved the problems of quarantine and risk reduction together. But as we all know, other couples and families were adversely affected, with more conflict while confined together in marriages that went from contentious to unbearable familiarity, and often then to an urgent need to divorce.

A spike in divorce rates, for example, was reported in Wuhan, China from the outset of the pandemic. Couples that had maintained their marriages by spending very little time at home together, usually with one member of a couple working in another city or traveling for work, were now locked in together. Some were suddenly much happier together. But many found themselves with a new and unbearable closeness, and their therapists had a new problem to deal with.

Some takeaways from our experience. Patients—especially couples—have had increased need this year, which has kept me and my colleagues even busier than usual. For therapists still learning the ropes of online appointments, here are a few ways to support the couples you work with:

  • We are all experiencing “PTSE” – Pandemic Traumatic Stress Experience. It’s not a disease. It is not PTSD. It is a shared experience of stress common to therapists and patients alike.
  • Acknowledge the differences in the way of working online that color the therapy.
  • Look for analogous differences in patients’ and couples’ lives that are highlighted by the experience in online couple therapy.
  • Connect their distress as a couple or family with the wider distress that we are all living with – our shared PTSE.

Thankfully, my colleagues and I are surviving the covid pandemic. Though we miss our freedom, we have been able to use our expertise to benefit both our students and patients in the newly virtual world. We’ll be glad to be able to meet patients in the office again and to meet each other in person at our conferences, but we all know that our ways of conducting therapy and training will never be the same again.

 

David Scharff, M.D., is Clinical Professor of Psychiatry at the Uniformed Services University of the Health Sciences, as well as at Georgetown University. He is also Co-Founder and Former Director of the International Psychotherapy Institute; Chair of the International Psychoanalytic Association’s Committee on Family and Couple Psychoanalysis;  Co-Chair, APsaA Advisory Committee on COVID-19, and editor-in-chief of Psychoanalysis and Psychotherapy in China. He directs training programs in analytic couple and family therapy in Beijing and Moscow.

Russia Letter

By David E. Scharff, M.D.

October, 2008

Our invitation to Russia came from one of our International Psychotherapy Institute Fellows, Patrizia Pallaro, who returned from teaching in Moscow to inform us that two of our books were being translated. Did we know about that? Several months of discussion later, royalties and permissions arranged in medias res, Lena Spirkina from Moscow contacted us to say she had heard that we were interested in coming to Moscow to teach, and that she would be glad to arrange that. Negotiations about the conditions and time of year followed, and a year later we flew to Moscow for a five day visit with another few days in St. Petersburg as tourists.

Lena Spirkina (next to Jill) and other colleagues at lunch
Lena Spirkina (next to Jill) and other colleagues at lunch

Lena’s daughter-in-law, Anna, met us at the airport after 20 hours of uneventful travel, and drove us to the hotel through rush hour traffic, which exists throughout most of the day and into the late evening. The dense traffic that has mushroomed in the last ten years stayed with us throughout our stay. Moscow is a grey city of 15 million with wide streets and communist architecture that includes 7 nearly identical Stalin Palaces scattered through the city. They hold functions as diverse as a government ministry, Moscow State University, and an apartment building formerly for the elite.

One of the 7 "Stalin Palaces" in center view
One of the 7 "Stalin Palaces" in center view

On our second night Alina Krivstova, a charming, generous young woman whom we had met a few weeks earlier in Washington, took us to the opulent designer jewelry store “Alena Gorchakova,” in which she worked, where Russian-style pieces of designer jewelry, with prices perhaps exceeding any store we had ever entered, were displayed. She then took us to a restaurant in the fashion of the elite communist 1950’s, and on a night tour by car of Moscow. It was the most beautiful view of Moscow we saw during our stay.

Our young friend Alina in the Alena Gorchakova Jewelry Store
Our young friend Alina in the Alena Gorchakova Jewelry Store

By day the same views of the city, although dotted by generous parks and two rivers, were a depressed grey, giving the impression of a traumatized populace who seemed never to look one in the eye. The buildings are grey stone and of a monumental scale that feels humanly diminishing. In all, we spent a total of three days as tourists, in palaces, famous churches and, most stunningly, in the Tretyakov Gallery – featuring an impressive and interesting collection of XI-XX century Russian art that had been given to the country. There are still more galleries we did not see, including the famous Pushkin Gallery, but we went to a wonderful opera concert — first row in an elegant hall — and ate in ethnic restaurants like our favorite, a Ukrainian restaurant decorated as a country inn. Borsht is wonderful everywhere.

Russian cathedral on Red Square
Russian cathedral on Red Square

Lena Spirkina and her colleagues were warm and gracious, helping us recover quickly from our doubts about what we had gotten ourselves into. They have been taught generously by IPA members from the US, including the couple Yulia Aleshina and Pasha Snejnevski who emigrated to Washington and worked with me at the Washington School of Psychiatry while beginning their analytic training more than 15 years ago.

Psychotherapy in Russia began with a group of psychologists that included Yulia and Pasha from Moscow State University. This group also included a seminal teacher who, having no access to Western psychoanalysis, had to make it up for himself and his students. Then a few, like Yulia and Pasha, got training in the West or even in Eastern Europe as it opened up after the Soviet Union dissolved in 1990 and psychoanalysis and analytic therapy were no longer forbidden.

Lena Spirkina, then in her 20’s, was among a small group of people invited to California in the 1980s — none of them as yet trained as psychotherapists — who were given red carpet treatment and a blitz of exposures to widely varying kinds of therapy. On her return, she decided that Russia had to have training, and she has over the years founded and developed the Moscow Institute for Psychoanalytic Psychotherapy. For a long time, the institute brought in teachers from overseas – many from the US, but also Europe, and then from the IPA who used shuttle analysis and seminars in Moscow to train enough people that there are now an IPA Study Group and local training analysts. But Lena is the heart and soul of the psychotherapy training. Although it is rigorously analytic, having evolved from being widely and tentatively eclectic, it has to teach basic academic psychology in order to receive state authentication. She is able to rent space in the state Institute of Psychology, but pays for that, and all the students pay tuition to study in this completely private institution. We developed an immediate and sustained admiration for her, her faculty and the students who sacrifice so much to learn what we, in our relative freedom and economic well-being, take for granted.

But there is really a more compelling case for this group of colleagues: Russia is a traumatized society. This generation of teachers and students come from families that grew up in the most traumatizing uncertainty, with parents under constant threat of being denounced, constantly on guard. Every family was either in fear of being undone or imprisoned, or among those doing the spying – traumatic in both directions. So both the therapists and the patients share this history in their social unconscious. Lena told us something of the dramatic and pervasive trauma to her family, spread through the generations, which I will not describe here because it is her story and I hope she will come to one of our conferences to tell it herself. But it makes clear that Russia itself has centuries of trauma, from the enslavement of the serfs, to the struggle to form a middle class that was abruptly cut off by the 1917 revolution, to the 70 years of fear, imprisonment and the death of 30 million people under Stalin. And then suddenly there was a shift. Nevertheless, while we were there, there were images of Putin on TV on his birthday, felling his karate teacher and marching through the forest bare-chested with a gun. It feels as though Russia is moving rapidly back towards the dictatorship that has been its state since the first unification under the Czars and that continued under communism. But this time there is a wealthy class, and a thriving middle class with education, and a sense of more political freedom to speak — at least privately — than in China.

So psychotherapy is a new boom industry, and Lena’s colleagues are hungry to know. They have formed a Society for Psychoanalytic Psychotherapy that forms the base on which formal analytic training should rest, and which offers to spread psychoanalytic application further than the limited reach that formal psychoanalysis can do by itself. Our brand of object relations theory, with its applications to family, couple and sex therapy – and even child therapy – is relatively new to them, especially in analytic form. So they are eager to learn.

Housed in the same institute building is the publisher of Russian psychoanalytic books, Victor Beloposky. A wiry, energetic white haired man, he bounced from his desk to greet us. Then we had an hour’s meeting trying to determine the best Russian translations of some of the key object relations terms. His editor and a translator are working on the third of our books that they will publish. After one particularly protracted discussion on the concept of psychological holding, the editor suddenly felt she understood and dashed from the room to get it down.

Victor Beloposky, left, with the editor and translator of one of our books
Victor Beloposky, left, with the editor and translator of one of our books

St. Petersburg is a stunning city! Palaces and broad beautiful vistas are surrounded by canals, rivers and the sea everywhere. The battleship Potemkin is now a museum docked on a quay. The buildings are painted bright colors, while the palaces are modeled on the 18th century European ones Peter the Great took as his model. Unlike Moscow, energetic people on the street look you in the eye. The depression lifts and even here, near the Arctic Circle on a chilly, bright October day, everything seems cheerful. The art in the Hermitage – mostly Russian and European – is stunning, although the Impressionist collection is much less extensive than I had imagined. But the palaces in the city and surrounding smaller towns, built by generations of Czars and their families in the 18th and 19th centuries, are magnificent. The Germans occupied the towns approaching St. Petersburg and almost completely destroyed the palaces, but they never made it into the city because of the heroism and persistence of the army and citizens over a three year siege. The palaces have been rebuilt from their gutting by the Germans with private and volunteer efforts and now shine as a tribute to the human spirit.

Palace gardens outside St. Petersburg
Palace gardens outside St. Petersburg
The battleship Potemkin's gun that began the 1917 Revolution
The battleship Potemkin's gun that began the 1917 Revolution

We met more briefly with a group of child analytic clinicians in St. Petersburg. They have been helped with psychotherapy and psychoanalytic training by the same Western and Eastern European teachers as in Moscow, but there are fewer of them in this smaller city. Warm and generous, Misha Yarish and his child therapy colleagues asked us to tell them about the rudiments of applying object relations to family and couple therapy, and concluded with the hope we would some day return to do more.

Misha Yarish (with beard) and child analytic colleagues in St. Petersburg
Misha Yarish (with beard) and child analytic colleagues in St. Petersburg

Russia has a small but rapidly growing number of colleagues who desperately want to know what we know, how we practice, how we work with patients. Like China, it has an enormous, long-standing history of trauma, although very different in detail. The number of informed colleagues may be smaller than in China, but they are better-educated and more organized in passing on and enlarging a foundation for future growth and work. They are eager for more help, making good on every opportunity, and in their resilience, their survival of a hundred years of trauma, they have a great deal to teach us in return.