A terrific supervisor once said that to me -- we practice what we believe. And I come back to it again and again as I see ever more clearly how much that is what our field is about.
Recently I participated in an online seminar sponsored by IARPP (the International Association for Relational Psychoanalysis and Psychotherapy) on the use of the telephone in analysis and therapy. Nearly all of the participants utilized the telephone for sessions at least once in a while and several had also experienced analysis as a patient utilizing the telephone. What interested me most was that it came down to whether the analyst is comfortable with the telephone, comfortable with the therapeutic space that forms between analyst and patient in that modality, that seems to be the determinant of how successful the work is. A few people, myself included, who have fairly clear ideas about how the therapeutic space is different -- different, not inferior -- from meeting in the office, expressed greater comfort with the use of the telephone than did those who simply do not like the phone.
In "Space and Place: The Perspective of Experience", Yi-Fu Tuan explores what makes a space become a place. As space becomes known with recognized landmarks, it becomes place. So therapeutic space is what exists when the patient first enters. The development of place, of home comes with learning the language and habitat of *this* therapist until that room becomes therapeutic place.
Each dyad of patient and therapist has to develop this sense of home, even though it feels relatively constant for the therapist. We have the challenge of opening to the strangeness of new with each new patient, understanding that in reality it is also new for the us because as the person sitting across from us changes, so does the place.
The therapeutic space which develops when the work is done by telephone differs from that when therapist and patient sit face to face, but it is therapeutic space nonetheless. When my patients call. I am sitting in my customary place, just as if they were sitting in front of me. And I suggest that my patient similarly be in the same place each time. We then create the space between us -- the sound of our voices and the time creating a temenos between us. Therapy works in part because it is contained. There is confidntiality, there is a fee, and a set time. Our work together is contained in this virtual space, just as it would be were we both in my office.
Constancy of place when speaking with patients on the telephone seems to me to be critical. We develop habits of how we sit, settle into our chairs, where we look and the like when we meet face to face with patients -- these are our rituals for entering the work with each patient. It seems to me that we need the same when working with patients via telephone. That is how on our end we create the therapeutic place.
I was surprised at how few of those who use the phone for sessions with patients do so in their offices, sitting as they would were the patient present in the room. And that they seem not to set a similar expectation for the patient.
My office is in my home. Whether I meet with a patient on the telephone or face to face, I sit in the same chair in my office. That is where I do my work. It would feel odd to me to wander about or sit in a different room. I strongly suggest my patient do the same, for those with whom I meet telephonically. And I explain a bit about why.
We practice what we believe.