[Phone sessions in Covid-19 environment: The frame and his limits]

Area of Science:

• Psychotherapy and Clinical Psychology
• Psychoanalysis
• Pandemic Mental Health

Context:

• The COVID-19 pandemic presented unprecedented challenges to established clinical practices in psychotherapy.
• Health protection measures required adaptations, forcing psychotherapists to reconsider the therapeutic framework, especially for telephone sessions.
• Historical parallels are drawn to ancient plagues, highlighting enduring human responses to existential threats like contamination and death.

Purpose:

• To explore the clinical implications of adapting psychotherapy to a pandemic context, focusing on telephone sessions.
• To examine the unique dynamics of telephone therapy, particularly the role and perception of silence.
• To reflect on maintaining the therapeutic alliance and framework amidst environmental and contextual shifts.

Summary:

• The study analyzes how the pandemic altered the therapeutic environment, impacting the transference relationship.
• Telephone sessions introduce challenges, with silence potentially amplifying anxiety and paranoid fantasies due to the lack of full sensory input.
• The authors use vignettes to illustrate diverse clinical situations and the need for flexible, case-by-case therapeutic approaches.
• The importance of the therapeutic environment, as highlighted by Winnicott, is re-evaluated, emphasizing the clinician's internal framework and adaptability.

Impact:

• The shift to remote therapy, especially telephone sessions, can lead to varied patient responses, including initiating therapy for the first time or discontinuing existing treatment.
• The absence of physical presence in telephone therapy alters the perception of silence, potentially leading to a sense of void or a 'partial object' experience for the clinician.
• This work underscores the need for psychotherapists to be flexible and adapt their practice to external crises while preserving core therapeutic elements.