Distance fear and intimacy in COVID time
This paper is written with much hesitancy and trepidation. My thoughts on the consequences of the plague we are all still experiencing change frequently. I do not know if and how the world will change, and I do not know how we will change as human beings and as therapists. And I have no certainty at all that the things I write now will seem to me relevant in several months.
I share with you some experiences that I am going through and address some issues that have been sharpened for me while working therapeutically with groups in the days of covid-19. These thoughts guide me nowadays and allow comfort and kind of road map.
I recently heard from an English-speaking colleague that in the English language, the word plague is used as both a noun—a rapidly spreading contagious disease that kills many people—as well as a verb denoting a psychic state in which one is deeply torn up inside by some persistent wound, trouble or distress. We can say that currently the world is plagued by four overlapping crises—the coronavirus, a climate crisis, an economic collapse, political crisis. Early on it became evident that people with certain underlying conditions are particularly vulnerable to the virus as well as there are others who are more privileged. But the virus also laid bare the world’s underlying conditions—a heartless economy, a failure to invest in the public good, and polarized population of poor and rich, left and right, young and old, religious and secular, black and white, etc.
I am aware of my own difficulty mentalizing the too-muchness of this moment, because we are in the midst of this threatening events, we are part of it, and with not enough distance from it. While I certainly have no new language to offer, what I can do is share with you some experiences I have with groups, filtered through the lens of my own sensibility.
So, we can say that we are in the middle of what seems to be an endless worldwide traumatic event. But how do we listen and what can we hear when fellow human beings become biohazards, silent invisible forces threaten our lives, and we recoil at home obsessively washing our hands, losing savings and incomes, fearful of the violence of microbes, politicians, and police? What impact does it have when the complexity of our senses—touch, unmediated looks into each other’s eyes, shared laughter—is flattened? When we understand that reality is always too much to digest, when we know that the principle of reciprocity but asymmetry between therapist and patients is shaken? What if trauma is not something to be uncovered from the unconscious of the patient’s memory but is potentially in our midst, happening to us, right here, right now
In my talk I relate first to some ethical and technical dilemmas that we are facing at this time of covid-19. I then relate to some issues that I faced in working with my small groups; and finally – how and why I worked with large groups (conducting and teaching).
The setting
How is it different? How do we work from distance? The passage to zoom and telephone and other means that technology gives us raises resistance in therapists and patients alike. The sometimes changes and oscillations in setting is outrageous, frustrating, and tiring. The loss is great – Loss of physical closeness, nuances and sensory communication, the trust, the non-verbal. However, does this loss compels us to question the meaning of the setting? We have to ask ourselves what is essential in the setting. More than ever, the essential and most important elements of the framework seem to be continuity, stability, and the effort to maintain trust and connection. Stolper and Zigenlaub (2021) discuss four central themes regarding the change of setting in pandemic time and quarantine that inhibits physical encounters: the visible and the invisible, the transition from a group conductor to a group host, the group stage of development during the transition to the Zoom format, and proximity versus distance. But even meeting face to face was affected by the pandemic. I certainly had to look for a larger room for my groups. And it was not easy to find one. My patients did not like the new space (neither did I). Still, I had to believe that the essential element of the framework is internal – our intention for the well-being of the patients, for their expansion of their inner world, of strengthening the sense of freedom. These elements are our job definition face to face or via online.
The responsibility for the setting is ours. And the question of risk is mixed with other ethical questions. Who is the one who determines whether we meet in person, with or without masks, or via zoom? I’m in a higher risk group of infection, but patients may also be in a high-risk group. How can my inner sense of freedom exist? These issues and more are inevitable from the central question – what sustains the possibility of sustaining good therapy?
Reciprocity and symmetry
When the pandemic first struck, we were all in a heightened state of reactivity. Lacking reliable coordinates, we didn’t know where we were, let alone where we were heading. Even the gradually emerging facts were hard to metabolize: the virus is deadly and highly contagious but easily killed with soap. Asymptomatic carriers can be super spreaders but it is also highly unlikely that one will be infected outdoors if proper distance is not maintained.
It is poignant that psychoanalytic and group analytic sessions begin these days with patients and therapists alike wanting, no, needing to know, if the other is “alright”, if he is vaccinated, if he is healthy. For a long time, my Chinese patient kept asking me in the beginning of every session if I put a mask on myself when I go out.
In many ways, a feeling of threat, uncertainty, and economic anxiety are common. However, the social structures that preserve injustice and inequality work harder in times of disaster. Not all of us suffer equally from the plague, and it is not just a matter of arbitrary fate. Being able to be in isolation is a privilege. The possibility of continuing to work from home is a privilege. The possibility of avoidance overcrowding and having better health services is a privilege; older age is now a big danger and young ones are more privileged.
In a more particular context – we are in a situation where both therapist and patients are in the same threatening and frightening reality. Uncertainty is common to both sides. How can we help from equal conditions? Reciprocity and mutual influence -always exists in therapy. We always have our difficulties, defenses, and anxieties. The asymmetry is not connected to our life events. Rather it is connected to our ethical intentions and the fact that we are there in order to take care of the patients. But now, this asymmetry can be shuddered and almost shattered when quite often we are in a more dangerous situation than our patients. I will relate to this later when I talk about working in small groups.
Technique
What has been changed in the technique? Is it right to do the therapy in another way when reality changed so suddenly and radically? What do we do when the group is not unified in its readiness to move into online meetings or sitting with masks in the room? How do we provide the right space for our groups? In my mind, the main thing that needs to be preserved now is the connection, the bond formed out of reciprocity and asymmetry. The bond that keeps the empathic, curious look, striving for human contact and emotional touch, even when there is physical distance. But, within the plague and its implications we learn even more that psychotherapy and group analysis cannot remain neutral and out of the overall context of the life of the people we help.
Small groups in time of covid-19
When the pandemic started, I had three analytic groups which I conducted by myself. Two are in Israel and one was abroad. I would like to share with you some of the problems that came up since the beginning of the acknowledged pandemic.
Let me start with the one which was abroad. I used to work with this group in block training 4-5 times a year. After 5 years of working together we decided to end our analytic meetings and go on only with supervision. I was supposed to meet them for the last time on March 2020. One week before I was supposed to travel to that country the borders of my country and their country were closed. I could not go for the final block, and I also knew that this will go on for a long time. How was I to conclude my work with this group? My decision was to have two months of consecutive weekly online meetings. Eight meetings for ending five years of working together. Of course, it was not an easy decision. But to me it seemed the best among other options. For half a year we worked on ending the group. We could not simply go on after that. But it was a poor option. And the anger, the rage of ending like this had to be worked through. I promised that one day, when the borders open, I will come in person to meet them in person. Until today I cannot go.
Regarding the two groups here in Israel – As soon as we had to move into online meetings (during the lockdown) two persons in one of the groups announced that they will not attend the meetings. They cannot and would not do it. For them it is not a proper way of meeting. I had to decide whether to give up the meetings because two out of eight will not attend. I tried to correspond with them. One was very stubborn and did not come. The other attended after some correspondence with me. I thought that maintaining the bond with even most of the members is more important than keeping the whole group unified. This issue occupied much of the first meetings online. I think that all those who attended the zoom meetings agreed that it was most important and also very meaningful. The guy who attended after I convinced him did some very important work in those meetings, but later, when we started to meet again face to face, he was extremely angry with me declaring that I put too much pressure on him. Both members paid for the two months although one of them was questioning the need to pay. Still both, saw themselves as part of the group although they did not join us on the zoom meetings.
Still – there are questions to address – should people who do not agree to attend zoom meetings pay for them? And more- who decides whether to meet online or face to face? What can we do with patients who refuse to be vaccinated?
Large groups in time of covid-19
Until recently large group theory in older publications describe the chaotic-aggressive, near-psychosis character of the large group, a certain contrast between the seemingly ‘benign’ small group and the ‘destructive’ large group and a predominantly dyadic relationship between the conductor and the large group. More recent publications underline the creative-constructive potential of the large group and the intersubjective interweaving of the conductor and the large group. Now, the main emphasis from this perspective is on promoting this potential and on the importance of communication and dialogue between the conductors and the participants even in large groups. The analytic attitude and intervention technique would be changed: the traditional position of strict neutrality, anonymity and abstinence as well as the emphasis on whole-group interpretations would be substituted by encouragement of dialogue and by a more open stance that does not hide the subjectivity of the conductor(s) but rather uses the conductor’s subjectivity to promote the analytic process.
On the day that we heard on the covi-19 lockdown, on the terrible situation in Italy and in Spain, I called a colleague of mine and asked him to join me in conducting a LG for the delegates and the members of all institutes of the EFPP. I had a feeling that in this time, when almost the whole world is in lockdown, when borders among countries are closed, there is a great need for connecting and this can be one of the best ways to do it. Borders are closed, but there are holes in the closed borders – technologies are creating these holes which are so important for our wellbeing.
I took some time (procedural issues) and we started on the first Sunday of April 2020. Within a couple of minutes we had 100 participants. Then I started receiving emails form people all over Europe asking to get in and we unfortunately could not let them in because at that time we were still limited to no more than 100 people. However, there was so much excitement in the meeting. At first it was very formal, and most of the people who were talking were Italian. But toward the end it was very emotional – stories about dead friends and colleagues; lots of associations anxieties and even a dream about Noa’s arc in the storm. Everybody was concerned mainly about people in Italy and Spain. There were also questions regarding behavior in LG.
Our interventions were mainly “holding” interventions, inviting participants to add and relate, explanations regarding administration. One interpretation was to comment about the impotence of leaders of countries – comparing it to the impotence of the conductors of the LG who could not allow more than 100 people to the LG space.
But we learned and from then on – we could hold even up to 500 participants. From then on for the next eight sessions we had more and more participants on each meeting. On each session we had participants from 21 countries in Europe. There was a solid core of participants on all meetings but there were others who came for just a couple of meetings. There were people who could hardly speak English and others translated for them. In the beginning there was fear of stronger emotions. But slowly people became freer in their expression of various emotions- loneliness, grief, anger and rage, etc. Some aggression among participants came up. Sometimes I was not reacting immediately, waiting for participants to balance each other. And then the central topic of fear of riots came up. On the fourth session one participant shared thoughts that she said she did not dare to say even in her individual therapy – thinking that the virus is evolutionally important and “cleaning the species” in a way that is good for humanity.
In the next meeting people were even more open and shared personal mourning on parents, catastrophic dreams, fear of the future and helplessness. Participants balanced each other so that after these sharing another guy brought some optimism to the group. On the 7th meeting one participant told the group about his 90-year-old mother who told him that she does not understand where does he disappears every Sunday evening, and whether he is going to Paris.!!! The story, content and way of telling it brought liveliness and vitality to the group. We had now Eros in the group. Participants, especially women, talked about the perfumes they put on for the meetings. We could almost smell through the web! One member from Russia told us that following this LG another LG was started in Russia for those who do not understand English. And others from other countries also told us about similar groups following us.
The last meetings were also dealing with the ending of this LG and asking for more meetings. It was very exciting when many of the participants brought with them flowers and showed them in the zoom windows for appreciation for our work.
I felt that this LG was most important for those who participated and offered a space for sharing, expressing emotions, love and most of all communicating and psychic touching where the virus, social distancing and closed borders could not make it possible.
The need for large groups was also felt by me when I decided, together with a colleague, to give a course on conducting large groups to group analysts. We decided to teach it online to a group of 15 people. Within a couple of days, we had more than 30 people on the list. The participants were asked to attend large groups that were running at that time, and were given theoretical papers to read. This course was successful and was another testimony for the need for such groups on pandemic times.
Concluding Remarks
As I mentioned in the opening, we are now faced with a three poles pandemic: health, economic and political. Unfortunately, having no faith in flawed real people, some people become true believers in an infallible fake leader. Authoritarian charisma is mistaken for love. And in this way, we have now criminally negligent leaders who use the pandemic to strengthen fascism and inner splits in many countries.
Now, for some individuals, breakdown feels imminent. This fear of catastrophe might be a prescient intuition of what is to come or an unconscious draw toward a catastrophe. We may feel a degree of panic at the arbitrariness of fate; yet most of us also have a sense of being among people, if not national leaders, who can protect us. In my country, I saw it in the demonstrations that took place all over the country, and the change of government. Although our lives may never be quite the same, let us speak at least as much about our fundamental resilience, our creativity, our tendency to communicate. In psychoanalysis we praise interdependence. We need each other because omnipotence doesn’t really keep us safe. The ease with which this virus is transmitted compels us to face how interdependent we really are.
Personally, I am more inclined to hope than to desire. Desire means that there is only one way to reach what is needed. Hope is not the conviction that things will turn out well, but the belief that things can make sense, regardless of how they turn out. “We’ve got to be as clear headed about human beings as possible,” says the writer James Baldwin, “because we are still each other’s only hope.” We are each other’s only hope because the damage humans inflict upon each other is far greater than what this virus can do. And because we can only really think when we have others to think with. This is why groups at this time are so important.
Especially during a plague, we need to keep each other alive and sustain each other’s aliveness. At a time of social distancing, we need to find common purpose in response to necessity. And to remind each other that even as people die, we can’t exhaust the human heart.
References
Mead, M. & Baldwin, J. (1971). A Rap on Race. Philadelphia: J.B. Lippincott Company.
Ofer, G. (2020). The impact of COVID-19 on Working with Groups. Lecture given to the community of mental health professionals in Istanbul.
Ofer, G. (2021) Distance and intimacy in COVID-19 time. Lecture given at the EFPP annual conference.
Stolper, E. & Zigenlaub, E. (2021). From the Circle to the Square: Group Psychotherapy in the Age of Corona Virus. Group: 45(1).