The Coronavirus Epidemic: Transference and Countertransference Considerations With Remote Therapy
Michael Blumenfield, M.D.
The Coronavirus epidemic has forced psychotherapists to see patients remotely as we are forced to follow social distancing and in many cases remain quarantined. I and others have made the case that remote sessions via Zoom, Skype, FaceTime, Doxy, and other systems are not only a safer method to follow during this time of the dangerous epidemic, but under certain circumstances may be more effective than the patient and the therapist sitting across from each other wearing protective masks. Remote therapy also eliminates travel time for the patient, which often is not only a safety factor during these times, but can be quite valuable as well as convenient for the patient. I have advocated that as long as there is any health consideration, this method should be continued and have also suggested that when the health crisis has completely passed, therapists and patients may favor continuing the utilization of remote sessions.
However, as we consider making remote sessions the norm, we have to examine how changes in the method of therapy will impact our therapeutic techniques. Particularly for those of us who are psychoanalysts or psychodynamic therapists, we will need to consider how utilizing remote sessions will impact transference and countertransference. As we know, “transference” is the phenomena where the patient experiences feelings about the therapist, which originate in the patient’s childhood usually from feelings that one had for primary relationship in childhood most often from emotions related to his or her parents. Often such feelings are initially identified by feelings that the patient had towards other people in the patient’s life, but frequently get more clearly expressed in the therapeutic relationship. The transference relationship is usually facilitated by the therapist being a more or less “gray screen” meaning that the patient usually knows very little about the therapist’s personal life or actual personality. There are exceptions in training programs where the therapist may be a teacher or may have a strong presence on social media.
Now with remote therapy, we have to take into account how the characteristics of remote therapy will influence the development of the transference, the distortion of it or the facilitation of it. If the therapist chooses to hold the remote video session in a setting which reveals their personal life (i.e., showing personal photos in the background), that certainly could distort or at least influence the transference. Obviously, this would be more likely to happen if children or other family members or even pets entered into the background of the setting. The fact that many remote setups actually present much more of a close-up of each participant’s face could influence the emotional experience of the participants. Also, the clothes that the participants are wearing, personal grooming or lack of it, will all influence the emotional experience of the participants. Obviously, all the factors which delay or distort transference will also impact countertransference. In situations where psychoanalytic therapy traditionally has the patient lying on a couch so they will not be influenced by the therapist looking at them, it would seem that a procedure would be developed where both participants after greeting each other would turn off their video setting.
I believe the transference and countertransference will definitely be influenced by remote sessions. I am confident that all aspects of transference and countertransference will ultimately take place but they no doubt will be influenced by the nature and characteristics of remote therapy. It will be incumbent that we use thoughtful observations how these may be barriers or distortions in transference and countertransference with this new method.
There is another aspect of how we use our new therapeutic experience to give us insight into the struggle of our patients. During the current and apparently prolonged health crisis, social contact especially between single people has become limited to remote visits and this fact of life in many cases is limiting and distorting the emotional experience of these relationships and becomes part of the struggle of the patient. It appears to me that the patients are uncertain how to evaluate their emotional attachments when the contacts are mostly or entirely via remote communication. By examining the nature of transference in remote therapy, we will provide a method to give the patient insight into this new struggle.
I am sure there will be many papers and presentations which will be examining these issues. At this time, I would welcome and invite any comments which you can write below.