Editorial

I had the good fortune to be taking up my role at a point when this issue had already been conceived and was taking shape. My predecessor, Lydia Hartland-Rowe and our Editor, Maria Papadima, had invited short papers about the impact of the pandemic on the work of child psychotherapists in the UK and around the world. Like a short report from the frontline, these papers have immediacy. As a collection, they serve as a snapshot of what has been possible during this time, but I have also been surprised and impressed by how much reflection and processing is already entrained. It will, of course, be a very long time before we understand the scale or detail of how the pandemic has affected our world. We might expect that it will be longer still before we can really understand how we responded in the consulting room and why. However, these papers give us a sense of where we are now and how fruitful such explorations are going to continue to be.

This issue begins with a review of the literature available, pre-pandemic, on technology mediated therapy, by Maria Pozzi Monzo and Sara Micotti. Most of the subsequent short papers in this issue describe individual work with children and young people and these are loosely organised under the headings: The experience of the therapist, and: The setting, technology and the body. There are a further three papers describing infant observation, group work and supervision during the pandemic. Each set of papers begins with a commentary, drawing out the themes of each paper, so I will not address that here. Instead, in this editorial, I want to describe what excites me about these papers as a collection.

All authors seem to share a central theme regarding the way that remote work brought the loss of, and consequent need to reimagine, the psychoanalytic frame. Some might argue that making this choice – to work remotely – was a manic defence; that we failed to mourn what we could not save. If there are clinicians who chose not to offer any work remotely, we did not hear from them at this stage. Perhaps those papers have yet to come?

My sense is that the liveliness in these pages indicates that the widespread choice to offer remote work is not manic, but the creative energy found here emerged out of a new and startling connection. Defamiliarisation is a technique employed in the arts, whereby the familiar is presented in a strange way, thus offering the audience a new perspective on something they had taken for granted as ‘known’ and so not worthy of much attention. Perhaps our habitual dominion over the setting had caused our relationship to the psychoanalytic frame to become a little automated. It is only when the machine breaks that the complexity of its mechanisms demands to be known. For me, a common theme in many of these papers is how the impingements on our ways of working have put us in touch with a part of our own practice in a way that is startling and has creative potential, rather like an interpretation, in fact! This is powerfully present in the concluding sentence of Gillian Sloan Donachy’s paper, when she says of her decision to take her final sessions with an adolescent into the park: ‘… would I do this again? Yes, even after a return to ‘normality’, I definitely would.’ A literal and metaphorical ‘breath of fresh air’, I felt. It is important to stress that none of these papers suggests that the setting is unimportant; rather, they remind us that we should interrogate what we do, in order to understand exactly what it is that works and why, and then notice when a thoughtful adaptation to technique might be helpful.

As a Journal, we too responded to the extraordinary situation by making an adaptation to our usual practice, in the form of asking for shorter papers. This was a practical consideration, as clinical papers often take years to percolate, take form and get re-worked. We wanted to engage and support our readership in real time. As mentioned, it is important to acknowledge that this represents a departure from the notion that it is not possible to work through a ‘trauma’ that is still live. But I would like to suggest that the generous act of thinking-out-loud and in-the-moment that these authors have offered might be an important model for us to hold in mind.

Covid and social injustice are mutually compounding (Kapadia et al., 2021), and we are beginning to feel this in our clinics and hear the figures on the news. It has been widely acknowledged that while we are all in the same storm, we are not in the same boat. Yet, there is little explicit reference to the details of this in our clinical papers so far. On our part, we are aware that psychoanalytic thinking has the potential to help us understand and challenge social injustice. Primitive anxieties, we know, fuel splitting and projection and attendant idealisation, denigration and defensive identifications; we have known this for at least 70 years (Fanon, 1952/2008). Yet we still don’t engage enough with the reality of social injustice within the immediacy of our therapeutic relationships, or at least we are not writing much about it if we do. Perhaps, if we allow ourselves to use the word ‘trauma’ in its broadest, rather than strictly clinical sense, then it might be possible to articulate an important problem facing our discipline. The ‘trauma’ of social injustice in all its guises (including financial and racial inequality), becoming so evident during the pandemic, is live in our therapeutic relationships too, sometimes in diffuse ways and sometimes in more acute ways. This sometimes makes it feel dangerous to work with.

I want to explore how some of the papers here have used the new perspective afforded by defamiliarisation to challenge various assumptions that are inherent in our thinking, in a way that might be helpful to those who do want to engage with social injustice in our relationships.

Some of the authors acknowledge that they, like their patients, were reeling from the shock of mass death and lockdown. Some go further and notice the ways in which they acted out in the work, particularly in response to the sense of destabilisation and panic at a loss of control – loss of control of the setting and loss of control over their own safety. We see how this experience, of all being rocked by the same storm, undermined what is helpful about the distinction between the roles and experiences of patient and therapist, the container-contained, etc. Some papers hint at something more, however: a sense that we may have also been defensively employing a ‘them’ and ‘us’ distinction, to shore up our sense of having something good to offer, which got thrown into relief when we found ourselves suffering the same storm. Our authors describe feeling ‘useless’, ‘incompetent’ and ‘impotent’.

This, in itself, challenges what I feel to be another false dichotomy that pervades many of our discourses, that between internal and external phenomena. The former is sometimes presented as where our attention should be focused, while the latter can be seen as a kind of dumbing down or distraction from our proper work. The enormity and entirely novel situation of the global pandemic has forced us to acknowledge that all that happens in our therapeutic relationships is an emergent property of the interaction between external and internal phenomena. The pandemic has inescapably got right inside the clinician, as much as the patient. Perhaps most importantly, this reality challenges the idea that our analyses might afford us a position that somehow transcends or protects us from being prey to circumstance and cultural influence.

This theme is courageously explored by Nupur Dhingra in her paper about ongoing therapeutic work and the way it changed during the pandemic. She identifies the therapeutic shifts that were made possible by the impact on her of the change in setting, but her as a culturally situated person: ‘As an Indian woman, I have been socialised to hide anger in relationships, which made acknowledging fury in the countertransference unprecedented, for me’. She noticed how not sharing a physical space with her patient meant that she had better access to her authentic responses to him. She felt less pulled to act in the maternal transference, and more able to be in touch with her anger. She also noticed how, by not having to manage the presentation of her body in the room, she was able to become more receptive to her patient’s projections, in a way that supported the work. She concludes: ‘It is ironic that in the physical distancing of lockdown, some of us found freedom in being the only body in the room, which enabled us to connect more meaningfully with ourselves, and in turn with one another’.

Other authors experienced the distanced and disembodied contact as a stripping of the embodied transferential relationship – a two-dimensional and impenetrable thing, lacking in vitality. Some report that their patients found ingenious ways of giving them powerfully embodied experiences. We learn of how different the experience is when a child spins in an office chair with the iPad in his lap, as compared to watching the same whirlwind from a stable monitor on the desk. In Ruth Schmidt Neven’s paper from Australia, we hear about a couple who had taken the laptop outside for a parent session, on the grounds that they could not expect privacy from their adolescent children within the house. This is presented as both a caution against letting the frame be eroded by the novelty of the situation, and a case of this being ‘grist to the mill’, in terms of what was communicated about the family dynamics. Finding ourselves beamed into people’s homes has been, by turns, both fraught with pitfalls and, at times, a potentially rich seam for most of our authors. Some found themselves looking at rather than observing in a more attuned way, perhaps feeling bombarded by all the detail of these new environments, and capturing less of the texture. This certainly resonated with my experience of teaching infant observation during the pandemic.

Other common themes include the quality of seeing and being seen through the camera lens – the impossibility of direct eye contact and the undertones of exhibitionism and voyeurism associated with the screen. Authors note how the frequent time lags, and the reality of being able to see oneself on screen, all lend themselves to a staged quality in the therapeutic encounter, and sometimes to the draining of spontaneity. Questions are posed about how the meaning of all this is made in the context of our patients’ digital lives that predated our entry into that sphere. Some papers track the therapist and/or patient’s trajectory through denigrating remote work and idealising in person therapy, through a manic denial of the loss, to the ability to start mourning it and move into the actual experience of what is possible.

With papers from the United States, Cyprus, Italy, Australia, Greece, Scotland, India, Canada and Israel, this is a truly international Issue and for this we can thank the passionate engagement of Maria Papadima with our international community. It is, of course, fitting to have a global response to a global pandemic and one of the many fascinating sequelae of the pandemic is that being forced to connect remotely has helped us realise what has, in fact, been possible for some time. In my teaching role, for example, I feel much better connected now to national and international colleagues than I used to do before. This is partly because we have now realised that we can easily hold remote meetings; but it is also because we have needed more of those meetings to plan a response to the new situation.

One silver lining of this pandemic is that we have come to see just how much change we can make happen when we are not in a position anymore to resist change, both at the societal level and in the consulting room. The pandemic has been a crisis that could not be ignored, but it is not the only one we face. I feel that these papers show us that we can change and adapt, without losing what is potent in our thinking. We are more resilient when we are less rigid and when we have the courage to keep testing our theories and techniques; this is how both have evolved to become more useful and have more intellectual rigour.

Disclosure statement

No potential conflict of interest was reported by the author(s).