By Blair Casdin, LCSW

“How are you? What’s new? How’s your practice?” The questions flew at me. Before I could answer, my cousin pressed on: “It’s definitely one of the things I would not go back to, I mean, it’s so much easier to do therapy online. You save all that time on commuting!” I felt depleted, and at a loss for words. 

It’s most therapists’ worst nightmare that no one will want to come back to the office. True, losing the commute saves time and money, and really, who wants to go back to riding the crowded, hot subway, which has recently seen an uptick in crime? Ubers are way more expensive, and, of course, mask-wearing is beginning to loosen, which makes some people anxious and reluctant to reenter the world. Teletherapy also means there’s no need to ask permission for time off every week, to attend a “doctor’s appointment,” wink-wink. So sure, doing therapy sessions from home does have its benefits. But for me, the thought of therapy on a screen for the foreseeable future feels dreadful. I find it exhausting. My brain seems to be working so hard to experience my patient’s presence from that tiny little box. 

My cousin had already moved on to the next topic of conversation as I gathered my thoughts and finally responded. “The experience of being in a room with someone is nothing like talking through a computer screen. You’d be surprised at how much you can learn about someone from the way they sit on the couch. Subtle cues get missed over a screen, important unconscious communications. It’s hard to describe exactly, but it’s a very different experience and, in my opinion, better. And believe it or not, that time you save on the commute is time you’ve lost to processing what happened in your session. With Zoom, people just click off a work meeting, click on to therapy for 45 minutes, and then immediately click onto the next work meeting. You have no time to gather your thoughts before the session, or let anything sink in afterwards.” “Huh, I never thought of it that way,” my cousin responded, crunching into a carrot with hummus. 

I’ve worked from five different locations since the beginning of the pandemic in March, 2020: three months in Massachusetts, the summer downtown in my old office, and then various spots in my apartment. When my daughter came home from college for the holidays, I moved out of her brightly lit room and into a makeshift space for the next five months. As the weather improved and the windowless space felt more and more like a bear’s cave, I realized I had to get outta there. So it was with great delight that I finally retrieved my furniture from storage and settled into a new, homey office on the Upper West Side mid-May. 

Last week I decided to sit at my desk for Zoom sessions instead of on the chair in the corner. “Oh, is that your new office?” a number of my patients asked. Even though I’d been there for a few weeks, they could see the couch now and the chair behind me. “Yup…and I look forward to when you come in and see it!” “Is that the same couch as before?” “It sure is.” I turn the computer monitor to give a glimpse of the whole space. “I like doing therapy from home, no offense.” This, from a long-time patient who relocated to New Jersey early in the pandemic. “I can wiggle around, wear what I want, and feel more comfortable in my own space.” “But don’t you like the new couch pillows?” I joked. I miss her presence, and I invite her in. “No, not really. I do miss seeing your dog, though. She was really soothing. And anyway, it’s still your space, not mine, and I really like being at home.” 

I thought of Lawrence Epstein, a beloved relational/interpersonal psychoanalyst and teacher who passed away in 2014. Something he said to me at a case conference has always stuck: “I am thinking psychoanalytically no matter what the context…whether it’s once a month over the phone or weekly on the couch.” From his perspective: “Just get them talking, in whatever way makes them feel safe to talk. For some people it’s lying on the couch, for some it might be a phone session.” 

To talk freely and openly a patient must feel safe and comfortable. And so do I, which is why I decided to rent an office again, to create a comfortable space where I can think more freely, without the dog, or the doorbell ringing, or the worry about other people in my home making noise. The same can be said for patients. We all benefit from a neutral space like the psychoanalytic office where thoughts can flow easily and freely without the intrusions of home, or, like one patient said last week, email notifications lighting up on the screen. 

Several patients who have come in-person, two of whom I had never met in person until now, find it preferable to the screen. And like me, we’re still searching for the words to explain why. “It’s like a reunion with someone you’ve been having a long-distance relationship with.” I agree with one patient’s description, despite the romantic connotations, because the relationship is intimate, and when we are together in a room there is a closeness that cannot be matched over a computer screen. 

Will they all come back? Certainly not. Can I keep working over Zoom? Sure. In a few short days last March, we therapists were thrust into doing therapy on our computers. The pandemic taught us that we can get used to anything, and even thrive in this new way of working. It is hard to know what the next phase will bring as many of us return to our offices. But psychoanalysis is an ever-evolving discipline and we can, we must, change with the times. Our work is about being in the moment, and meeting the moment. 

 

Blair Casdin, LCSW, is a graduate of the Manhattan Institute for Psychoanalysis. At MIP, she is founder and former co-editor of the Analysis Now blog, co-chair of the Colloquium Committee, and teaches Dreams I. Blair is faculty and supervisor at the Institute for Expressive Analysis where she teaches Basic Clinical Concepts. She is in private practice in New York City.

 

 

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