On Disembodiment, Dissonance and Deprivation – Why Remote Psychotherapy in the Time of COVID-19 Is So Taxing

Padfield, Lisa Rae

Against the backdrop of the global outbreak of Covid-19, the question of why therapists experience remote psychotherapy as more taxing than traditional face-to-face encounters, is interrogated. From an experience-near perspective, I draw on concepts such as reverie, the frame, and holding;self psychological constructs such as self-states and empathy;and reference emotion regulation from the perspectives of neuroscience and social psychology.At a meta-level, this different way of working is unusually tiring because rapid change without warning in response to a pandemic—which is happening to therapists too—is intrinsically demanding. Anxiety is a key consideration. At a finer scale, I proffer a set of ideas regarding the implications for core aspects of the psychoanalytic scaffolding: how reverie can be hampered and confidentiality compromised;how holding can become less reliable, empathic attunement harder to maintain, and therapist self-cohesion disrupted. In consequence, the therapist has to work harder. The heightened importance of therapist self-care, ongoing professional development, and the need to hold the frame in mind, are suggested as strategies for ensuring clinically and ethically sound practice.