Continuities, discontinuities and transformations in the psychotherapy of a psychotic adolescent during the time of coronavirus.

The author describes the evolution of the psychotherapy of a psychotic adolescent in the period when the pandemic induced their national authorities to impose lockdown. The difficulty of coming to terms with an ever-present reality that proved to be distressing for both the patient and the analyst, as well as with the violence and rapidity with which the external situation developed, leading to a change in the therapy setting, are at the heart of the reflections in this paper. The "choice" of whether to continue the sessions over the phone determined the emergence of some distinctive issues related to discontinuity and to the impossibility of relying on visual perception. However, to the analyst's surprise, it also favoured the possibility of working through the meaning of some autistic mental areas which, up to that moment, had never really been accessible to verbalization. Questioning the meaning of these changes, the author develops a broader reflection about the way that, for analysts and patients, modifications in the frames of our daily lives and clinical practice have enabled the deployment of undifferentiated parts of the personality which had previously been secretly deposited in the "body" of the setting and therefore were inaccessible.

Working Online During the Contemporary COVID-19 Pandemic.

Within the psychoanalytic school there has been substantial and ongoing debate about the efficacy of teleanalysis. However, as a result of the current COVID-19 pandemic and the online work with which the Jungian analytic community has now had to engage, this paper initially focuses on analysts' actual experiences of working by teleanalysis. These experiences highlight a range of issues like "Zoom fatigue", "online disinhibition", dissonance, confidentiality, the frame and working with new patients. Alongside these issues, there were ample experiences by analysts of both productive psychotherapy apace with analytic work involving transference and countertransference phenomena, all indicating that a genuine and good enough analytic process can occur with teleanalysis. An overview of the research and literature both prior to the pandemic and as a result of it, confirms the validity of these experiences so long as analysts are cognizant of the specifics of such an online modality. Conclusions to do with the question, "what have we learned?", alongside training, ethics and supervision issues are subsequently discussed.

Au sein de l'école psychanalytique il y a encore un grand débat sur l'efficacité de la télé-analyse. Toutefois, du fait de la pandémie actuelle de COVID-19 et du travail en ligne que la communauté analytique Jungienne a dû entreprendre, cet article se concentre initialement sur les expériences actuelles de l'analyste dans l'analyse en ligne. Ces expériences soulignent une variété de problèmes tels la « fatigue Zoom ¼, la « désinhibition en ligne ¼, la dissonance, la confidentialité, le cadre, et commencer avec de nouveaux patients. Aux côtés de ces questions il y a eu pour les analystes nombre d'expériences à la fois de psychothérapie productive et de travail analytique, contenant des phénomènes de transfert-contretransfert. Cela indique qu'un processus authentique et convenable du point de vue analytique peut avoir lieu dans la télé-analyse. Un repérage des recherches et de la documentation effectuées à la fois avant la pandémie et suite à celle-ci confirme la validité de ces expériences, du moment que les analystes sont conscients de ce qui est spécifique à une telle modalité. L'article aborde ensuite des conclusions sur la question de ce que l'on a appris, sur la formation, l'éthique et la supervision.

Dentro de la escuela psicoanalítica ha habido un debate sustancial y continuo sobre la eficacia del teleanálisis. Sin embargo, como resultado de la actual pandemia de COVID-19 y el trabajo en línea con el que la comunidad analítica junguiana ha tenido que comprometerse, este artículo se centra inicialmente en las experiencias reales de los analistas de trabajar vía teleanálisis. Estas experiencias ponen de relieve una serie de cuestiones como la "fatiga de Zoom", la "desinhibición en línea", la disonancia, la confidencialidad, el marco y el trabajo con nuevos pacientes. Junto a estas cuestiones, hubo amplias experiencias por parte de los analistas tanto de psicoterapia productiva como de trabajo analítico con fenómenos de transferencia y contratransferencia, todo lo cual indica que puede darse un proceso analítico genuino y suficientemente bueno con el teleanálisis. Una visión general de la investigación y la literatura, tanto antes de la pandemia, y también como resultado de ella, confirma la validez de estas experiencias siempre y cuando los analistas sean conscientes de las especificidades de esta modalidad virtual. Posteriormente se discuten las conclusiones relacionadas con la pregunta "¿qué hemos aprendido?", junto con cuestiones de formación, ética y supervisión.

Through a Glass Darkly: a clinical journey.

The use of the empathic mode for engaging and communicating with patients has become widely accepted by many psychoanalytic psychotherapists since Kohut's early formulations (Kohut, 1971; Atwood & Stolorow, 2014). However, diagnostic understanding based on ongoing empathic immersion with our patients is often complicated because it is continually being modified as we know them more deeply and as transference and countertransference factors influence our perceptions. To illustrate the complexity of diagnosis when it is grounded in ongoing empathic engagement with our patients, I describe in detail my treatment of an elderly woman who initially presented with severe and acute symptoms of psychological, cognitive, and physical impairment. As the treatment has progressed, my diagnostic understanding has been continually modified to include a combination of psychodynamic and organic factors including PTSD, intense unresolved grief, and extreme feelings of guilt and need for punishment. Adding further to this conundrum, I have been frequently challenged by my own responses to the fluctuations in her progress, especially to periods of hopefulness followed by periods of despair and regression.

A COVID-19 Patient's Request to Die and Ensuing Conflict: Psychodynamic Considerations.

The role of psychodynamic theory in consultation-liaison (C-L) work, and particularly the importance of countertransference, has been well established. The psychological impact of the COVID-19 pandemic on healthcare workers is a new factor that must now be taken into account as C-L psychiatrists traverse a changed healthcare landscape. In this article, we highlight the case of a critically ill COVID-19 patient who endorsed a desire for hastened death. This request generated significant conflict between the physicians and nurses caring for him, and it became challenging for the C-L team to perform our typical liaison function. We briefly review the existing literature on the psychological impact of the pandemic on healthcare workers, and examine how psychodynamic factors within this context impacted the events that unfolded. Themes under consideration include the effect of mass trauma on clinician defense mechanisms, and specifically the impact on countertransference toward patients who express a desire for hastened death. C-L psychiatrists themselves are not immune to such reactions and must be particularly attentive to emergent conflict in such cases. Interdisciplinary meetings to discuss and process these disagreements may be effective in repairing staff ruptures.

Practicing Psychoanalysis at the Intersection Of Covid-19, The Murder of George Floyd, and Trump's Presidency: Reflections from a Brown Analyst.

The author focuses on some of her experiences as the COVID-19 pandemic began and her retrospective understanding of those experiences. She describes having drawn on memories from her early life to arrive at this understanding; she discusses how this process has allowed her to move past certain countertransferential obstacles in her clinical work during the early days of the pandemic and to listen to her patients with more optimal analytic attentiveness. The author also discusses concurrent sociopolitical events, such as Donald Trump's presidency and George Floyd's murder, and how these impacted her analytic work. Illustrative clinical vignettes are presented.

Shared Catastrophe, Resistance, and Learning in the Countertransference.

In light of the 2020-2021 pandemic and consequent necessity for radical changes in psychoanalytic treatment, the author discusses transference-countertransference, resistance, and the analytic setting, among other themes. In particular, the author explores how elements of regression induced in patient and analyst during times of external challenge sometimes obscures elements of unconscious conflict and fantasy that analysis mobilizes and can help to elucidate. He explores an element of the analyst's work with his own resistance to learning about what this catastrophe means psychologically to our patients and to those trying to help them. Three illustrative clinical vignettes are present and discussed.

Together - apart: in touch in a time of separation.

This paper explores the experience of working as a Jungian analyst through the various phases of the global COVID-19 pandemic, examining the importance of the physical containing space alongside the analyst's internal mind and how technology can both help and hinder understanding. A number of clinical vignettes illustrate the challenge of communicating over a distance, paying particular attention to the way countertransference phenomena can become re-attuned. Reference is made to mythology and symbols of hope, and consideration given to the meaning and purpose of the pandemic.

Cet article étudie l'expérience de travailler en tant qu'analyste Jungien à travers les différentes phases de la pandémie globale de COVID-19. L'article explore l'importance d'un espace physiquement contenant aux côtés du monde interne de l'analyste, et s'intéresse à comment la technologie peut faciliter mais aussi gêner la compréhension. Plusieurs vignettes cliniques illustrent le défi de communiquer à distance, s'occupant particulièrement de la manière dont les phénomènes de contretransfert peuvent s'en trouver accordés d'une nouvelle manière. L'article fait référence à la mythologie et aux symboles d'espoir, et considère le sens et le but de la pandémie.

El presente trabajo explora la experiencia de trabajar como analista Junguiana a través de las diversas fases de la pandemia global COVID-19, examinando la importancia del espacio físico de contención junto a la mente de la analista y cómo la tecnología puede tanto contribuir como obstaculizar la comprensión. Un número de viñetas clínicas ilustran el desafío de comunicarse a la distancia, prestando particular atención al modo en el que la contratransferencia puede sintonizarse nuevamente. Se presentan referencias a símbolos y mitologías de esperanza, y una consideración al sentido y al propósito de la pandemia.

The empty couch: Love and mourning in times of confinement.

This paper describes the psychoanalytic treatment of a woman patient during the first six months of the COVID-19 pandemic, when the setting was profoundly disrupted and was transferred from in-person psychoanalysis to telephone sessions. Drawing on Bleger's formulations on the construction of the analytic frame and on André Green's on the function of the framing structure in the construction and elaboration of phantasy life, the case study shows how, in the absence of the physicality of the setting, the most primitive anxieties about the symbiotic relationship with the mother were expressed and contained in the transference and countertransference in the analysis. The author offers some considerations about the notion of "background of the uncanny", derived from Yolanda Gampel, which draws attention to the challenges when both patient and analyst are inserted into the same traumatic wider context. It is suggested that the production of an art object by the patient during this period represents a step in the elaboration of the work of mourning and towards symbolization.

Teleanalytic Therapy in the Era of Covid-19: Dissociation in the Countertransference.

While we and our patients have many transferences to the modality of video or telephone therapy, these meanings are ultimately not intrinsic to the medium itself. Rather, they are symbolic meanings we make of the modality. This paper discusses the symbolic meanings that we attribute to teletherapy and the ways we may use these attributed meanings to dissociate the trauma of Covid-19. It also explores the clinical opportunities in identifying these dissociated countertransferential experiences and embodying them in our own and our patients' experiences.