Some thoughts about the transition to an online weekend conference  

Jill Savege Scharff

Because of physical distancing to combat COVID-19, the International Psychotherapy Institute (IPI) moved its April weekend conference on sex and gender and its student graduation ceremony from the usual site in Rockville to IPI’s 1000-capacity Zoom room online.  I thought it was a good decision, and I planned to be there.  I had attended a number of online Town Halls and was quite used to seeing all the attendees in their electronic squares in gallery view across multiple screens, or a large image of a single person in speaker view.  However, in the week before the conference, I was still thinking of scheduling enough time to drive up to Rockville.  I was still anticipating meeting colleagues in the flesh.

Once the conference began online, I resonated with comments about what people were missing – the time after the session to meet and greet in the hallways, the pleasure of embodied presence, giving a hug, comforting someone who had lost a friend or loved one.  Electronic social time was scheduled but was barely used.  Once these aspects were acknowledged and mourned the large group seemed able to work.  Members got used to entering their requests to speak on the chat, and the co-chairs held the center, monitored the chat and called upon participants to speak during the discussion periods. One member spoke of his hatred of physical deprivation and of having to look at his colleagues in their little boxes.  It reminded me of the Pete Seeger song written by Malvina Reynolds, “little boxes just the same.”  But each person seemed far from the same to me.  The variety of backgrounds and size of image within the frame reflected the personality of the person within.  To me, the online setting offered one great improvement.  Instead of looking at the backs of heads as people addressed the speaker or the panel in the Rockville hotel, I was looking at faces, and I could see everyone perfectly.  Although it is a 2-D image, the speaker view brought me very close to a real live person, perhaps because of the size of the image, but more likely because of the affect being expressed.  We broke into assigned small groups five times during the weekend, each group using its facilitator’s own Zoom room number, and that worked well.

People speak a lot about being fatigued by the effort of being online all day.  I felt fine on Friday.  By Saturday the relentless pace had got to me.  I needed to take part of the afternoon off to relax, get some exercise and fresh air.  I missed a presentation that was important to me, and then a small group.  Missing those was a loss I had to take because the conference schedule was too tightly packed for me and for many others.  During the conference, I got an email announcement of a conference that was to have been in Panama in October would now happen online instead. I had intended to go because of wanting to work with my colleagues in Panama, but now I faced a choice: do I want to attend a conference online in three languages?  I tried to tell myself that it will be easier to listen to just the English translation without having to tune out the language of the presenter and the interference from other headsets, and cheaper than traveling to Panama.  But for me it would be so much less enjoyable because of my particular attachment to the place and the people.  If this notice had not come in the middle of a packed conference schedule, might I have responded with more enthusiasm?

This bears on the decision I must make about attending the APsaA conference in June, now also online.  IPI’s director is asked to help ApsaA plan for that transition.  It is an honor for IPI to be recognized as having experience in reaching across a distance.  So, I should want to attend, but I am not drawn to it.  What had drawn me to IPI’s event was the subject matter, the conference design, and the object relations analytic perspective.  The weekend was organized on a theme, with participants studying, responding, discussing and developing the theme.

On Sunday, the conference had its first technical glitch.  The director worked feverishly but with an outward appearance of calm as she put in place an alternative gathering place.  Reminded of the old days with frequent technical problems when IPI teaching was frequently interrupted on the old Polycom system, David Scharff felt that current participants now knew what he and those early classes had put with.  Someone offered him “technology empathy”.  Since the director and many of those leading the current day’s events had experienced those days too, they rolled with the punches.  On this occasion, the host-administrator was locked out of the IPI Zoom room.  She could not reach the Zoom representative to arrange for a new number.   It was explained that Zoom had scheduled an update unknown to us.  The director and the administrator worked together like lightning to inform 72 participants of a switch to the director’s own Zoom room number.  The conference start was delayed by 15 minutes to allow everyone to log on, and the schedule was quickly adjusted in consultation with the conference co-chairs and session co-chairs.   We saw a fine example of grace under pressure.  The ensuing case presentation and discussion proceeded smoothly thereafter.

Last came the graduation.  The convenience of the online venue meant that lots of family members and friends from far away could attend. Faculty described the qualities of individual graduates from IPI’s psychotherapy and psychoanalytic training programs.  Students spoke of their experiences of pain, challenge, perseverance, passion, and reward. Lots of congratulations and praise for work well done was mixed in with sadness of leaving behind group members to whom people had become close over two  to four years.  Some were laughing at silly skits.  Others were in tears at the beauty of a song that captured saying good-bye to a friend who would be missed.  True, this graduation was devoid of physical copresence, but there was no lack of affect.  The closing ceremony felt like a salute to psychoanalysis, to a vibrant, sturdy organization carrying on in spite of the corona virus, a demonstration of the life force over COVID-induced death anxiety.

Changes in Frames: COVID-19 and Teleanalysis

 April 2020

 

Yolanda Varela, PhD, President, IPA Panamanian Association of Psychoanalysis (Provisional Society); supervising analyst, IPA; supervising analyst and graduate, APsaA International Institute for Psychoanalytic Training.

 

Thoughts arising at Town Hall Meeting:

Changes in Frames: COVID-19 and Teleanalysis

 

With so many countries under lockdown to flatten the curve of the COVID-19 pandemic, the frame of life and work has completely changed.  Analysts who always conducted analysis in their private office, now are forbidden from traveling, and must stop practice or continue to see their patients in virtual space, each connecting from their own home. As always, crises bring opportunities for new experiences for us and for our patients.  I would like to address my experience under three headings: the use of teleanalysis, the early anxieties that are stirred in the patient, and early anxieties that are stirred in the analyst.

 

The use of teleanalysis

Unlike some of my colleagues who had never engaged in technology mediated treatment, I had experience to draw on.  I had already completed a personal analysis with an ApsaA certified analyst, and much of it was necessarily conducted using the telephone at first, and later using Voice over Internet Protocol with web camera.  I had had a full analytic training too — but not one that was approved by ApsaA.  Then FEPAL (Psychoanalytic Federation of of Latin America) authorized ILAP (Latin-American Institute of Psychoanalysis) to offer psychoanalytic training in Central America, as a global outreach project of the International Psychoanalytic Association.  When ILAP arrived in Panama, one of its requirements was that analytic graduates like me who had already completed a personal analysis would have to do an extra 200 hours of condensed analysis “in-person”  that is, traveling to the city where our analysts lived, or meeting in Panama with an IPA authorized analyst newly immigrated to Panama.

 

In order to meet the new requirement, I would do the extra hours.  I decided to travel to the United States to resume with my analyst, but what I chose to do with the extra time in analysis was to focus on what is not represented in me, on my early anxieties.  To address these effectively, I decided to continue my required in-person analysis with four-times-a week videoconference technology mediated sessions between trips to the United States.  For me, analysis “in-person” continues to be the preferable one, but at no time were transference and countertransference aspects lacking in the technology-mediated portions of the treatment.  In fact, it was the change in the frame that evoked the very early anxieties and enabled me to analyze them.  This experience gave me confidence in the use of teleanalysis.

 

Now I am analyzing my own patients in Panama in traditional, in-office analysis.  Occasionally I am asked to do teleanalysis.   For this, I establish new rules.  First, I use the most secure and stable platform (in my case ZOOM) and I don’t let the patient decide the platform.  Before each session, the patient receives a link to access the session with a password that only the patient knows.  I explain to analysands that they should look for a private place, where they can recline, similar to the office couch, with the camera on one side and behind them, simulating my position inside the office.  I greet them with the usual greeting, they recline and lose eye contact with me, but if they turn their head back, they will be able to see me.  I think we should stick to rules for technology mediated treatment that are similar to those in use for treatment in the office.  Beyond these arrangements to secure the external frame, I also shift my internal frame.  It was José Bleger’s article on the psychoanalysis of the frame that helped me to develop my technique in teleanalysis, and so help my patients. Bleger asks us to analyze what lies hidden behind the traditional, well-established frame.

video camera

Early anxieties of the patient

During the past three weeks in quarantine because of COVID-19, I have been transitioning my in-office patients to technology mediated psychoanalysis and psychotherapy.  Because of social distancing to fight the COVID-19 pandemic, analysands usually treated in the office must now set up a private treatment space of their own choosing.  At first, the sessions are dominated by worries about getting sick, the loss of social contact, and being trapped at home with children while trying to work. Behind the emphasis on COVID-19 lies the loss of the analyst’s physical presence and the loss of a safe office, which now seems like a uterus from which the patients were extruded.  Having to see the analyst on the screen, and put up with the times that the image freezes as well, the analysand feels as if the analyst is removing affection.  These fears of loss of response and loss of love result from early fears related to the dead mother.  Fears of viral invasion echo fears of the mother’s death drive, drowning the patient’s desire for life.  Feelings of hopelessness, helplessness and lack of trust in agencies that are supposed to protect us (hospitals, government, Ministry of Health) reflect early attachment insecurities, and convey transference to the analyst as an unreliable object.  With the change in frame from in-office analysis to teleanalysis, I have been able to observe the expression of very early anxieties in analysands who were previously seen only in the office.

 

Anxiety of the analyst

Freud’s warnings about the dangers of changing the frame of analysis are echoed by our own psychoanalysts, supervisors and colleagues, especially when confronting any change from the traditional in-office setting to the teleanalytic setting. Teleanalysis is frequently regarded as a transgression. The transgenerationally transmitted superego will have to be somewhat pacified to understand the current situation as a necessary and effective adaptation that brings us the possibility of continuing to work and of countering the guilt of not being able to do more for our patients, a problema that Eizirik pointed out in a recent IPA webinar.  Patients come to us with a fear of death and we receive them with our life drive.  To support our life drive, we need to pursue our own pleasure and part of that  is our work. We will have to continue to be linked to life, taling with colleagues in Town Hall meetings like this, keeping in touch  with friends and family, accepting and not denying reality, but without being suffocated by it.