The therapy of the presence: exploring the clinical dilemmas of continued face-to-face psychotherapy with a male adolescent during Cyprus’s Covid-19 lockdown

ABSTRACT

In this short paper, I want to examine the function, and a number of ethical and clinical dilemmas, in deciding to continue to work in the consulting room with an 18-year-old boy during the first Covid-19 lockdown in Cyprus. This patient displayed a borderline organisation of the schizoid type, with a marked false self presentation. To understand this work, I build on Winnicott’s theories, as well as Monica Lanyado’s ideas. Lanyado explores how the presence of the therapist and that of the therapy itself acquire functions beyond those commonly defined within the psychoanalytic framework – in this case, due to the nature of the collectively experienced phenomenon of the lockdown. Local circumstances, restrictions and realities in Cyprus are described, as they occurred at the time of the first Covid-19 lockdown, showing how the patient’s pathology became intertwined with the above conflicts and dilemmas that I faced as his psychotherapist, and as a fellow member of the local and global society. I argue that under such unusual conditions, psychotherapist and patient become part of the same local and global collective, and only if they work ‘hand in hand’ can they survive a collectively experienced trauma, at a time when most human contact was forbidden by law.

KEYWORDS:

• Face-to-face psychotherapy
• psycho-social implications
• Covid-19 lockdown; unconscious to unconscious communications
• presence of the therapist

Acknowlegements

My huge appreciation to Nick Sanderson for the support and thinking in clinical supervision of this case, during these challenging times, as well to Maria Papadima for carefully guiding me through editing this paper, and to the anonymous reviewers for their helpful contributions. I also thank Thomas for his courage in consenting to publish this paper.

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Notes on contributors

Nikolas Antoniades

Nikolas Antoniades trained as a child and adolescent psychoanalytic psychotherapist at the British Psychotherapy Foundation (IPCAPA), after completing preclinical requirements at the Tavistock and Portman. He worked clinically in CAMHS NHS teams and held a Senior Child Psychotherapist position, in a service supervisor role. He has been involved in Education and Training at the Tavistock and Portman NHS Foundation Trust as a visiting lecturer, and co-Organising Tutor for the Introductory course: Developing a diverse child and adolescent workforce (CPD64). Recently he has relocated in Nicosia, Cyprus, where he works in private practice. In collaboration with local prematurity organisations and other professionals, he has been active in putting in place European Standards of Neonatal Care for Mental Health as set by the European Foundation for the Care of Newborn Infants (EFCNI), by providing parental support in NICU, running reflective practice groups for NICU staff, and providing (parent) infant mental health training. He is a also a peer reviewer for the Journal of Child Psychotherapy.