28 Mar ‘Touching from a distance’ – intimacy and imitation affecting the therapeutic relationship.
Well, I’ve not blogged anything for banish the crows for a very long time! Too long, probably. I’m not great at it and truth be known, I’m not mad keen on it, either. I’m just not a natural blogger and would rather have ‘real’ conversations with somebody sitting with me. However, blogs have their place in the world of ‘right now’, so I best crack on with what I have to say here.
Two things happened recently, resulting from the UK Government’s (inevitable) partial ‘lockdown’ as part of the state of emergency responding to the coronavirus (COVID-19) pandemic. It being the right thing to do, given our circumstances and the current existential threat that we are all undoubtedly experiencing, at some level. In a bid to survive and to offer whatever continuity that I can, to my clients, I have needed to join ‘the crowd’ (not very good at that, either) and offer alternatives to face-to-face meetings. Instead, phone work (mobile-mobile) or online/video-chat – so-called, ‘online therapy’, or even e-therapy, which is pretty much a no-no for me; not my thing at all, although I do recognise its place in the modern psychotherapies. I’m not new to it (phone, online work). I recognise that I have worked successfully with a number of clients with whom there was a pre-existing therapeutic relationship – in my opinion this being significantly important. One, a person who left the area but wanted to continue our work; two others who were studying locally and returning to their home town during the summer recess. These methods can be proficient; don’t get me wrong, and enable us to feel heard and ‘held’ therapeutically, and offer options for continuity, but in my experience it is never quite the same as ‘two people in a room’; one opposite the other ‘in our chairs’, where feeling held is much more tangible, where the nuances of bodily expression (mine as well as the person that I’m sitting with) is witnessed by the other, where the smell of the room and the textures of fabric and the familiarity of the room can be experienced, in chorus. That sense of ‘intimacy’ which is somehow denied due to absence and distance. Some clients told me this when I wrote to them earlier this week with some asking to temporarily ‘suspend’ our work together until the lockdown is relaxed or eventually, lifted. One client talked of phone and online means as not offering enough ‘contact’ for them and another feared missing the ‘direct time’ that we spend together, uniquely and safely. Two neat ways of putting it. But I also feel these things too – I am a partner in this collaboration of two people, figuring out together. I am flesh and blood. That’s how it goes.
Anyhow, in a bid to get myself back up to scratch; ‘on point’, as they say, with the online method, myself and a very dear and enthusiastic colleague of many years trialed Google Hangout, Skype, WhatsApp and Messenger video calling. It was a muddled evening. Earlier that evening I had written to all of my clients to inform them of the temporary cessation of our face-to-face therapeutic work and the interim closure of our office at St. James House in Longton. All the time feeling gutted but knowing it to be the right thing to do. I felt that the rhythm of my work was disrupted that I was being forced apart from people with whom I had worked hard with to establish the fundamental tenet of therapy – ‘relationship’. For some clients the therapeutic relationship is particularly strong and enduring – sometimes over several years, others long months spent together. How will we weather separation? Speaking with my colleague I found myself becoming unusually (I think!) petulant; bawling: “I don’t want to do this…” and “I don’t like it…” and “…it’s not my way”. My child-self really very present. She endured me and we found our resolve but I think that she is more optimistic and enthusiastic than I. That is who she is (and I am thankful for that). She keeps me going as much as my clinical supervisor might (and does).
Then this evening before taking my dog out for her evening walk (the streets eerily silent) I had a Facebook friend request from somebody with an ‘odd’ name that I quickly realised was a pen-name for reasons known only to them – professional, I imagine. I investigated us having two mutual friends and made contact with one of them – a student whom I taught at a local University a couple of years back, to see ‘who’ this person was/is. He told me and I accepted the other person’s request to friend-up. She was another student from two years ago. I hold an affectionate regard for both, which reminds me that I do so miss lecturing on a regular basis – it was a special time and, in many ways, worked well alongside my clinical work at banish the crows. I got to fix my own ‘attachment’ needs by remaining professionally connected and in truth, emotionally involved with the institution (not to mention the ‘mothership’) where I studied and trained. I returned on a visiting basis this year and hope to repeat this in the next academic year but that feels too far away and with everything going on right now, hard to contemplate.
I’m off track!
So, what is it about what we are being forced into doing? Not meeting ‘in person’ but hopefully continuing to ‘meet’ in a different way. Psychologists tell us that maintaining social contact and attending to our relationships is really important and of course, I entirely get that – it is equally essential in the therapeutic relationships that are formed between me-and-my-clients and my-clients-and-me. Alongside the reality of isolation comes the subjective experience of abandonment and loss. The impact of isolation for all of us is profound in the moment and will undoubtedly be felt in the weeks and months following the public health pandemic easing. Psychologists also say that the best and most effective way for us all to maintain contact with each other is by one person seeing the other (or others) – this being the next best thing to regular human presence and touch. They are talking about the online; facetiming, whatsapping, facebooking. But whilst I am prepared to do it, for my clients, I am somehow resistant to online video calling – what is that about?
If I cannot be with the person face-to-face then I’m happier to talk over the phone, I realise. During a phone call I am completely attentive and ‘with’ the person that I’m engaging with. I have to be. I have to listen hard – headphones help with that. The best thing is the feeling that the person has ‘climbed into my ear’ and thus ‘into my head’. I really hear them and they really hear me. It’s as intimate as it can be, without being together with them and has a dynamic all of its own. Freud’s early psychoanalytic theories around the use of ‘free association’ offered that a quite different technique – asking a patient to lie down, without making eye contact, to say whatever readily came to mind – could provide new insights for themselves and their analyst. So, I wondered, not having the physical presence of ‘being together’, not sitting opposite or adjacent to each other, not having eye-contact, can induce the same phenomenon as if the person was ‘lying down’ – their therapist sitting behind or alongside them. There’s a thought. I have known clients share more deeply and openly what has not been shared in our face-to-face consultations. Is it coincidental to the stage of process or is it that on this occasion we cannot see each other and thus free association and deeper more intimate sharing becomes more possible – with unexpected gains in the work together?
Doing this – not ‘being together’ (in each other’s actual presence) has its challenges. Both phone and online methods require a safe and private space to talk. For people with partners and family in social isolation, this is a very real challenge, more so than for those who live independently but even then, there are phantoms; ‘spectral actors’ – people who might once have lived there with the person; ex-partners, deceased family. The fear of being ‘overheard’, even when we are not or might not be, but knowing that others are in the house; or once were, is likely to affect our ability to be fully present or fully disclosing. Psychological interference is experienced. Are we betraying the person in a room downstairs or the parent who once tucked us into bed, in the room next to this one? These are unconscious phenomena that can and do play out, psychologically and transferentially. In the interplay between technology and humanness how much plays out in the ‘broadcast’ (phenomenon) of the online world – am I me or an image representing me through a screen. For the therapist we are entering an unfamiliar place – in our client’s homes; we might hear their partner shutting a door or climbing the stairs. Hear a voice of somebody that we do not know; a parent, a child; somebody who is significant in our client’s narrative. Is this helpful or unhelpful ‘data’ for the therapist?
And the same will be true of my client’s experience – being in my habitat, my world, a space that typically and purposely we do not make available to them as part of the therapy process. The person knowing or sensing that my partner might be closing a door or climbing the stairs – even if my space is safe and private. There is much to consider.
So, I’ve jumped around a bit but I hope what I’ve talked about here is of interest and import. For me there is ‘nothing like the real thing’ – being with the person that I’m ‘for’; that I am connected with in the unique way that being in therapy affords to us all. There is truly no other relationship like it. Not at all. Being distant due to social isolation is challenging – critical even, but is necessary right now and we do not want ‘social distancing’ to create ‘distance’ in the psychotherapeutic sense. But for me it’s like seeing the grass but not smelling it; not touching it, not feeling the texture. It is ‘touching from a distance’.
In closing, we will find our way through this – the isolation, in our own ways but also together. There will be learning at a micro- as well as macro-level. Clients and their therapists will learn new things about their ‘togetherness’ and the effects on it – the good and potentially, the less good (hopefully not much of the latter). We will gleam new insights and some of these will be immediate; others will come to light later in our work when we reframe, once more, ‘being together’ again and reviewing the dynamic of what just happened in the world and happened to us, in therapy.
I want to thank the two students who played a part, inadvertently, this evening in triggering my thoughts and then this blog. My text to the student that I sought advice from about who the other was, said: “intimacy is possible in a different way [on the phone] as the person ‘climbs inside your ear and your head’. Deeper shares are more possible for some of us without physical witness. In this sense, phone work does not seek to mimic the face-to-face experience. It is not to be underestimated but strong therapeutic alliance is needed first, IMO. Conversely, the online world is an ‘imitation’ of the face-to-face; trying too hard to be the familiar, and is thus, inferior – again, IMO”.
It may be a long time before I blog again; hopefully not, as it was a cathartic process for me. It became much, much longer than I anticipated but I do have track record for that…
Well done if you made it to the end!
‘Stay safe and in touch’. Jem Boughey. 28 March 2020.
Readers of this blog can access our Guidance for to clients for using telephone and online / e-therapy for further information and tips when using either method.