Report from the trenches

I'm writing my impressions about my work with the patients during the first week of quarantine. I feel immersed in the uncertainty and incredulity, as well as they do.

The statement “Istayathome” was presented in an individual way but it finally turned into a law, and it has been felt as a lockdown, confinement, isolation, imprisonment and many other meanings that are constantly echoing inside ourselves.

I have been always used to having remote sessions and I feel comfortable with them, but the scene has abruptly changed due to a virus and its spreading, which have quickly modified the situation. We have gone from one day to the next to “no-working”, “no-school”, “no-traffic” and “no(?) session.”

The restriction of not leaving our homes led me and also some fellows to offer our patients to continue the face-to-face sessions as remote sessions or even phone sessions. Leaving behind the particularity of each case, I would like to point what appeared during the sessions:

Both of us are in the same boat
I could notice how some patients included social empathy and solidarity in their speeches:

-- “I was thinking of stopping coming because of financial fears, but I also thought that both of us are in the same situation. If I stop coming here and my piano students do not come either to their lessons, we all lose”.
-- “Coming here is a way of being together. It is better not to isolate ourselves, this is good for us.”

I strongly believe we are all used to an asymmetric mechanism where being peers is not making us remove the differences between us but show conscience of humanity. In the same way, there is another clinical data to be taken into account: the popping-up questions about myself, my homeland... thus the idea of the analyst as a person is getting stronger. Moreover, both the patient and the analyst feel the need to have the questions answered.

It's not the moment to fantasise!
The anxieties developed during the sessions increased speeches very closed to reality. In these first moments of astonishment and perplexity, it becomes more important what they have achieved, maintained and not lost, as well as who are the ones that I care about and who I have to take care of, than the fantasies about this phenomenon.

-- “I have talked to my mother and she told me not to hesitate on asking her for financial support.”
I also noticed the intention of improving family lifestyle.

--“My husband and I stopped fighting and we are trying not to argue.”

The reality is global but it is progressing step by step
Temporariness is another variable to take into account when working on remote sessions with patients from different countries and time zones. Sometimes, a patient says “good morning!” and the analyst answers “good afternoon!” However, this State of Alert situation has resulted in an odd condition since the measures taken by each country have not been taken simultaneously. That is the reason why this odd condition has turned up: either the patient or the analyst is living in the present while the other is about to live it at a later time. That way, the analysed and the analyst share the psychic, the material and even the global reality.

What happened then was that, because of these retarded times, the patient was dreaming, wishing and fantasizing, whilst I found myself in a strange role of representing the reality or as a seer of the coming future.

“I would like to go on holidays to the beach, but I do not know if my boss will allow me to.” (While in Spain the police were restricting the passage on the highways because people were happily going to their second homes. In the country of my patient, that would happen within a few days.

Organizing the new consulting room
The quarantine requires a need for adjusting the daily routine at home, and especially when there are several members living at home. From then on, we have to face many problems like where to locate the session and changing the time if necessary. It does not only depend on the size of the houses but also on many elements (schedules, noises, shared rooms, interferences, etc.), as well as the importance of the analytical space for the patient.

Some scenes turned up:

-- “I'd rather have the session when my wife goes to buy bread”

It is also a problem to troublesome teenagers that feel they do not have a private space since “my parents are everywhere.”

Furthermore, there are many parents who find it challenging to have a moment of reflection since they do not have time for themselves because of their children.

-- “We decided to have the session in the garage since it is the only room available”.

The no-session

When I suggested having remote sessions to my patients, not all of them accepted. I understand there are several reasons that prevent them from “attending” the sessions: there are people who do not like telematics either because of ignorance, fear or lack of real presence. There are also people whose mental space is almost entirely immersed in the virus, so they cannot imagine they can share their views and start working on their feelings. They just think “what am I going to talk about?”

Some other people are very engaged in tasks needing their active presence “fighting against the virus”. We must also consider that our culture implies the psychological is not something we have at hand nor a common resource. “It is not necessary seeing a psychologist when we have so many external problems...”

While I am finishing this writing, it has been announced that quarantine will last longer. I wonder how the time extension, the uncertainty and the progress of the disease will affect all of us.

As Silvia Bleichmar says in No me hubiera gustado morir en los 90 (I wouldn't have liked dying in the 90’s), nations can live for a long time filled with fears that only trouble our daily routine but, in a moment, everything takes an unexpected twist and war or crisis burst into our lives. Perhaps, “the pace of the nations is simply that: the right to the pleasures and private fears.”

I wish we get them back!

Adriana Szlifman Gersztein Clinical Psychology Seville

References
Bleichmar, Silvia (2006). No me hubiera gustado morir en los 90. Taurus. Buenos Aires.

Image by Alan Kirwan from Pixabay