A little over a year ago, on 4th March 2020, the first DPCM (Decree of the President of the Council of Ministers) was issued and it put us in front of something we would never have imagined. At first it seemed to be a matter of one, maybe two weeks but then it became more and more clear that it would have lasted a long. The virus was no longer just a problem confined to Wuhan and not even to Codogno, it circulated everywhere and the risk of contagion had suddenly become real.
I suddenly found myself, after so many years of individual and group psychotherapy, unable to do my job.
I knew about colleagues who moved, seamlessly, to online psychotherapy. Others who instead, taking advantage of very large premises, continued psychotherapy “in presence”. With regards to this last option, two things worried me: to make people, especially kids, move in public transport with this virus around, and perhaps even more the idea that someone might feel eventually responsible for infecting me. Everyone in the industry knows how hard it can be to get over an idea of guilt of this kind by a patient.
As for online psychotherapy, I had done interviews in the past with this mode but they had always been emergency situations, mostly patients who had moved abroad during treatment. But I never thought about doing online psychotherapy on an ongoing or permanent basis, let alone a group psychotherapy.
I couldn’t get my bearings, I needed time. Initially I postponed for a week, then for another, I even thought of fractioning the groups making them smaller to be able to respect the distances imposed, but the risks of contagion I spoke of still seemed too high. So, I decided to suspend psychotherapy for three weeks, never happened in so many years.
I knew that the greatest violence that can exist in a psychotherapy (and not only) is the absence but if we limit ourselves to considering the absence in material terms it would mean not having understood anything of the absence itself. I thought in fact that the real absence would be to propose online psychotherapy in the aftermath of the DPCM. Why? Because I was not convinced: having to put a glass, an inanimate object, cold, between me and the patients left me very puzzled.
I was in danger of getting confused, of not being sure I was doing it for them: but what if it was my need? If the therapist needs the patient and not vice versa, psychotherapy ceases to exist. I had to wait, decant that moment, get a clear vision, I needed time. I knew, I felt that the patients would have understood that the unplanned break was not an absence, even for the relationship that had been there until then. I had however given my availability to all those who had requested it, to see each other at the studio or online. Except for a very small minority, the patients managed to wait, certain that that a sudden pause was not an abandonment.
At that time a debate took place among colleagues I knew, in which I did not personally participate. A very heated debate in which there were two very distinct factions: the ones in favour of online and the ones against it. I must be honest: that debate has served very little to unravel my uncertainties also because I have always thought that the setting (i.e. that set of agreements on the modalities of psychotherapy, the time of the session, the location, the honorary, the summer break, etc.) is something that gets defined between therapist and patient and no one outside the two can put their mouth on it.
I remember how much it made us smile to know that at the conference of the PSI (Italian Society of Psychoanalysis) many years ago it was decided, for all analysts, how many sessions they should have done a week. One year they moved them from five to four! Everything regardless of the patient, actually not, by analysing what was in front of them. They even went so far to say that it was the setting that cured: but when ever! At most, it is a control, a containment, a support but that the setting can cure does not exist at all. The essential function of the setting is to keep out of the session the so-called examination of reality, to address once and for all the practical issues so as not to have to get back to them, thus allowing in the session itself there is only a profound not rational relationship.
Two episodes come to mind. One was about 30 years ago, when I was attending the Special Psychotherapy Service of the Faculty of Psychiatry. I brought a clinical case to discuss with colleagues and the professor. It was a girl I was following at the Mental Health Center. At one point I said that with this girl the sessions lasted thirty minutes: open up Heavens! The most imaginative interpretations began: “you only see her 30′ because you don’t like her!” and “you can’t stand her!” and things like that. I didn’t dislike her at all or anything. I just thought it would be better for her. I managed to put an end to those bizarre interpretations, asking a naive question: “But why, in your opinion, what is the right duration of a session?” The general silence followed!
Another thing that comes to mind was when I decided to abolish the couch. Until then there had been extensive dissertations on the validity of the couch in psychotherapy, however that couch no longer corresponded to me, it didn’t feel good anymore and I abolished it. I understand that the vast majority of colleagues are no longer using it today.
But let’s get back to the point. After those very long three weeks, having clearly I mind that a further prolongation of the pause could have compromised the very sense of psychotherapy, On March 29th, I called everyone on Zoom to announce that the next day we would have resumed psychotherapy on an online platform in a way, so to speak, experimental. It was a thrilling meeting and there I understood and we understood that we would have been able to break the damn glass that frightened me so much because I knew very well that a psychotherapy without the feeling of the body is useless. Or maybe it serves to become good, wise (know-it-all?) to have “learned” a lot of things without having transformed their own internal reality, thus becoming fundamentalists preachers of psychotherapy who vomit on the next one things swallowed but never made their own.
So we found out that not only could we do psychotherapy online, or rather we could do it, but that it also allowed us to put the space in brackets and have the group appear at that hour and then disappear after two hours or two and a half hours and this way to create, in solitude, that fantasy memory so important after a successful session, eliminating the idea of community that does not always get along with a valid psychotherapy.
It was as if that situation forced everyone to find a wider internal reality, a greater affectivity. Dreams of having a larger house, or of having a room that was previously unknown, multiplied.
And, perhaps also because of this damn virus, which made us realize how easy it is to get sick in closed places and forced us to open the windows, that Papillon was born, a breath of fresh air! And I left the associate firm, which no longer corresponded to me.
Today online psychotherapy allows us to continue our relationship with a kid who goes to Erasmus, with people who live abroad or far from Rome, to start a psychotherapy wherever the other is, and that’s not a small thing!
All clear then? Maybe not but research, fortunately, continues…
Marco Michelini
Thanks to Chiara Fanasca for the translation of this article
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