ICAPP Working Remotely Meeting 2 April 28, 2020

This is a summary of the discussion of meeting 2.

A Preference for Zoom

It was recognised that most of the group felt more at ease with working online. Some of the initial anxiety had lessened. 

The first issue that was raised was the question of whether some people may prefer to have their sessions via Zoom even when the pandemic is over. This was discussed in relation to adolescents. Some clinicians felt that having a Zoom session was more convenient for young people as it was less disruptive to their daily schedules. Having the 50 minutes on the screen, and not travelling to and from the session could allow adolescents to attend more of their after school activities.

This led to the question of the plus and minus of travelling to the session. If this was with a parent this was seen as a possible positive time with a parent  – being together in the car, or a negative thing in that the adolescent may feel more pressure to talk about their session to the parent.

Should the therapist keep open the option of a Zoom session with an adolescent after the pandemic. This however may raise a financial issue, for such a session via telehealth may not be rebateable.

The Screen as a  Protective Defence

A number of people found some children and adolescents were much more emotionally  engaged via Zoom than when they were actually in the room. It was wondered if the greater distance provided by the screen enabled them to feel safer to reveal their emotional worlds. It was noted that some hard-to-reach children and adolescents may paradoxically be easier to reach within the safe distance of Zoom.  

Issues with Adolescents

It was wondered if the convenience of a Zoom session in their home may make it easier for poorly motivated adolescents to be involved. However it was also discussed that having a session in the home may not be private enough for some adolescents, feeling their parents are too close by.

Working with Young children

It was generally agreed this is a very difficult age group for the use of Zoom. Some people reported the movement in and out of the shot of the camera made it difficult to know if the child was doing this purposely – and may be communicating something in this ‘there’ and ‘not there’ activity, or is the child not aware that when they move they may not be able to be seen by the therapist. Others felt that this movement away from the camera may be a reaction to feeling invaded by the focus of the screen. It was wondered if this was similar to an infant who has to avert their gaze when eye contact with another is too much. In regards to this feeling of the small child feeling invaded one therapist shared her experience that this intensity of contact seemed to be diluted when she played with dolls and spoke to the child through the dolls. This enable the child to re-engage. 

Who controls the session?

It was generally agreed that the loss of the familiarity of the consulting room made it difficult for the therapist to make sense of certain things. For example a small child was moving around so much that the therapist could not see them. Yet it was unclear to the therapist whether the child was purposely doing this or was not aware that when they moved away from the camera the therapist could not see them. 

Relatedly there was the issue of who begins the Zoom session. Should the therapist open up the session, with the child and/or mother be the ones who wait, or should the parent do this, putting the therapist in the waiting position. It was reported that there was further uncertainty in some cases as the child or parent was not always in the same room when the Zoom began. The child could be in their bedroom, the bathroom or the family sitting room. Others also reported the child being in the middle of a meal when the session began.

Shallow Symbolism

There followed a discussion as to whether it is possible to be fully emotionally engaged with a child or adolescent via the use of a screen. Does the absence of actual bodies in the room make the emotional contact feel ‘virtual’? Clinical material was presented of a child and adolescent who played a great deal with screens in the consulting room – one with a video game and another with detailed discussion of movies. While the material from both these cases felt very rich with symbolic meaning the therapist felt it was emotionally flat and wondered if these symbolic representations had a two dimensional quality to them, so the feeling were symbolically communicated but were not actually felt or emotionally connected to by the child and adolescent. This raised the issue of whether the use of a screen made it difficult to fully engage in an emotionally experienced way. Some people felt the remote contact did not prevent close engagement, suggesting the sensory cues of the sounds and movements on the screen were enough to feel there was a deep connection.

Report of the U.S Psychoanalytic Association Forum on remote working

Some participants shared their experience of joining this meeting.  One of the main messages from this meeting was that clinicians need to explore what will work for them – that clinicians should try and see what works – that it was important to see what frame is possible with each case. It was also reported that therapists should not lean forward into the screen but rather sit back in a relaxed position and make an attempt to move their body about, replicating what would normally happen in a face to face meeting.

The Need for the Therapist to have some Thinking Space

Some therapists found the intensity of the screen to screen contact to be too intense and exhausting. They experienced looking at the screen drew them away from having some space to think and have their own thoughts. In this regards some preferred the phone than the video as this seemed easier to remain in contact but at the same time to have moments of reflection.

The Need for Personal Contact

The issue of feeling exhausted was raised in relation to not having the child or adolescent in the room. It was felt that therapists are fellow human beings and need to have direct contact with people in an embodied way – that there was something deeply unsatisfying in the remote contact.  

Infant Observation via Zoom

An interesting discussion arose from observing an infant through the lens of Zoom. This happened to a group who had begun observing the babies in their homes but then the virus made this impossible and all the mothers agreed to do this via Zoom. The observers noted that a number of mothers focused the camera on the baby in their crib. They noted the relative absence of the mother and her interaction with her baby. Watching only the infant in this completely focused way enabled the observer to totally immerse themselves in the experience of the infant. This heightened the emotional intensity of the experience. The group wondered why the mothers had done this – was it a relief to ‘hand the baby over’ to the observer. Some of the observers felt like screaming out for the mother to come into the shot of the camera – is this what the babies were feeling, or was it something the mothers were feeling – all alone with no one around. This in turn made the group wonder if this reflected a possible dynamic that is very powerfully experienced in the lockdown of the pandemic – the new mothers did not have family and friends coming to be with them and importantly supporting the ‘socially distanced’ mother.

The Meaning of the Pandemic for children

The forum thought about what was the meaning of the pandemic for the small child. What impact did it have on the child that intimacy was possibly dangerous. Even the therapist and child could not be in the same room. What sense did they make of people wearing masks? This also led to a discussion of the effects of the social environment children and adolescents are now experiencing. The background of global warming, the current Australian bushfires and now the pandemic must make the child sense this constant backdrop of uncertainty and danger.  

Notes taken by Peter Blake