"Private practice has been my goal as a therapist and the pandemic has made that easier for many therapists since telehealth is more accepted. I am grateful for starting my private practice during the pandemic as the demand for therapy increased more than ever. I was grateful to have a few colleagues that also started their private practice around the same time as me which has allowed us to form a monthly supervision/consultation group in which we discuss questions or issues in the practice. My experience with Headway and Alma has been great because they have been a big support for therapists in private practice. They help with all the paperwork when getting paneled under insurance companies as well as handling all the billings and invoices. Alma also does a great job with having therapists on a listserv where you can ask questions, find or receive referrals and just have a community of therapists that can help you with almost anything!"

• Humaira Naushad, LMHC
  Psychotherapist

"In treating patients during the pandemic, one thing has become abundantly clear to me: typical models for diagnoses and pathology fall short. This is especially clear with symptomatology related to depression and anxiety. So many clients have come seeking treatment during the pandemic crisis to address their surging anxiety and sinking depression, and many of whom will report no history of depressive episodes or overly active anxiety. So for clients like these, are we to believe that their biochemistry is now out of balance because of a genetic onset of latent MDD or GAD? I think for many new to the field, this is something they might be inclined to suspect from the medical model of abnormal psychology. I would rather propose a different viewpoint for clinicians at this point in time, a reminder of sorts: not all depression and anxiety is pathological.

Two terms that have helped me understand this are "congruent" and "incongruent." If someone has lost their job, lost a loved one, struggled to pay rent, had to move into a shelter, endured terrible illness, changed their entire way of life, limited their socialization, etc. then we know that their depression is not brought about by the onset of imbalanced serotonin and other neurotransmitters, but rather that the environmental, social, societal, and overarching circumstantial factors are the root cause for depression in the present moment and the anxiety for days to come. I would say I learned a great deal in recognizing when a person's depression is congruent to their conditions; it makes "sense." This is true for anxiety as well.

And while we have to diagnose for insurance purposes, I think it is important to recognize the significant difference between someone having a disorder and someone whose life is in disorder, as many of our lives are these days. I think keeping this in mind also can be very helpful for walking our clients through what they're experiencing in a way beyond a medical, and perhaps cold manner. In truth, it's always been the case that people in society will present with anxiety and depression because of the circumstances they face in their environment and or an excessive lack of needs being met. The pandemic has exposed this like it has exposed many other flaws in our society. I have tried hard in the last year or so to be attuned to the needs of my clients and as such, I think the fallout of the pandemic shows just how important it is for needs to be met for mental wellness, and how equally important it is for us a clinicians to be mindful of how we conceptualize the depression and anxiety we are seeing in our clients. "

• Augustin Lianzo, LMHC
  Psychotherapist

"To the COVID-19 pandemic, we have lost: human lives, health, the rituals that wove our ordinary lives together, hope, a sense of futurity, safety (personal and institutional), freedom, embodied connectedness, the fantasy that we are not going to die (even if we spend endless hours in the gym and eat healthy and organic), the illusion that we are fully in control of our lives. The new reality enforced by COVID-19 has also made us lose a clear demarcation between inside and outside, yesterday/today/tomorrow, fantasy and reality, private and public, near and far, personal and professional, wellness and illness.

We have lost a sense of home, or, homeliness, even if we are spending most of our time there. Our human home has become unhomely, unfamiliar, because we have lost some of the boundaries that make us feel secure, stable. In this sense, the coronavirus crisis, and the virus itself, is the embodiment of the uncanny: 'something which ought to have remained hidden and secret but has come to light,' in the words of Schelling. The internal and external rites meant to keep us oblivious of mortality, of our vulnerability, of the abject disparities of our society, of the radical contingency of life, have been radically unsettled. I hope this helps us better understand how the poor and many immigrants live consistently.

However, the body is not lost in virtuality. It is transformed. The Spinozist question is: what can a virtual body do?

The therapeutic space is a physical one but also one that we hold in our minds. Some people have never had the experience of being kept in mind over time. This can feel confusing or lonely or scare or anxiety producing or like a form of psychic death.

The virtual shrinks space and time and brings people closer. Both the living and the dead. It also connects realities that were disjointed before, oblivious to one another. This interconnected closeness challenges all sorts of distinctions: inside/outside, mind/body, far/close, important/banal, new/old, fiction/reality, private/public, alive/dead, memory/oblivion. The virtual seems to propel everything towards a progressive state of oneness. The virtual seems to propel everything towards a progressive state of oneness. The virtual is viral in the way that it reproduces itself but also in that its blurring of boundaries can sometimes feel claustrophobic; as if, like from COVID-19, there were no escape, as if it pervaded it all in visible and invisible ways.

One of my patients noticed that we did not know each other's height. I had never thought about this fact. It has all kinds of specific and idiosyncratic meanings for this person. Indeed. But also: the difference in height between psychoanalyst and patient could be an important carrier of unconscious meanings that perhaps we don't pay enough attention to or talk about. Or simply: what does it mean to have an ongoing, emotionally charged conversation with someone whose height we do not know?

What's the fate of the body in teletherapy? I think much of it, though by no means all, becomes inscribed in, or projected onto, the screen's surface. Also, many aspects of the analytic process get encrypted within the virtual medium itself. This needs to be kept in mind and interpreted at the right moment. I remember Freud, "The ego is first and foremost a bodily ego; it is not merely a surface entity, but is itself the projection of a surface." The ego is also a screen, a projection of the body's surface. The virtuality of the treatment reenacts and reinforces this scheme."

• Carlos Padrón, MA, MPhil
  Psychoanalyst

"How do we imagine that going permanently remote would not be detrimental to the practice of treatment? What is psychoanalysis without bodies? Real, living bodies in a shared physical space. We would never ask that live arts like dance be permanently remote. Why degrade psychoanalysis in that way? I've invited and encouraged all of my patients to return to coming in the flesh. (Of course there are some exceptions.)

For patients who are in the same city and want to continue remotely only because it's easier and more comfortable to stay home, I would ask why would we expect that therapy be easy or comfortable?

I appreciate the separation between home and office. I ride my bicycle from my home to my office, literally crossing a bridge and experiencing the distance in a visceral way. I absolutely love moving my body through the world and I can't stand Zoom. No one will ever stand in awe before Freud's Zoom room. I imagine his real office smelling of musty cigars."

• Julie Fotheringham, LCSM
  Clinical Social Worker, Therapist

"For me, having moved abroad my analysands are remote, and I've decided never to return to a physical office space. I say, to each their own. Each clinician should decide what's best for themselves and their practice. I don't think my practice has been degraded in any way by remote treatment. In fact, remote work made my practice continue to be possible when I was in the process of immigrating. And people living in remote areas who otherwise do not have access to psychoanalytic treatment have been able to engage. So I would be careful about making such broad sweeping statements. What is best for one person's practice may not be best for another. I don't think one should or will replace the other, but I do think the more options people have to access treatment and psychoanalytic treatment, the better. I’ve also used remote analysis with people who travel a lot for work... business people, actors, etc. and in that way being able to have analysis remotely actually provides greater continuity of care, as they can continue having sessions from the road, instead of missing weeks at a time due to travel. The more options people have to access treatment, the better.

I also have undergone an analysis remotely, so I have experience on that end as well, and I can say I think remote treatment works just as well as in-person treatment. There may be differences, but for every drawback someone tries to bring up there are just as many positive aspects, such as reaching people in remote areas where there may not be any psychoanalysts, or the only psychoanalyst may be expensive, or full, or someone known to the person, or may have seen a person’s friend or family member. Also for people who are home-bound or disabled and may not be able to leave home or may have difficulty leaving home. Or for people who work from home, they can more easily fit it into their work day. It could be great for people who have small children to be able to conduct treatment from home. There are so many reasons. And as we’ve seen from this time of the pandemic, so many jobs are able to be conducted from home. I think in the future many more people will be working from home and will appreciate being able to have therapy/analysis remotely."

• Vanessa Sinclair, PsyD
  Clinical Psychologist & Psychoanalyst

"On the topic of comfort, I wonder whether we might be prioritizing our own comfort of being in our office and thus on our selected space over our discomfort at Zooming into our patients spaces. It’s been truly fascinating to navigate the various spaces people do therapy in (whether they’ve had to by lack of choice or if they have been fortunate to have options). Similarly, I’ve been thinking a lot about the people who’ve come into my therapy (either private practice or at the college I work) who might not have come if it were in person."

• Philip Rosenbaum, PhD
  Psychotherapist & Psychoanalyst

"Whenever I hear an advertisement for something that can be done “from the comfort of your living room,” I grow wary. Perhaps I’m skeptical of comfort; perhaps—as someone who has never found domestic spaces terribly comfortable—I’m on the lookout for false advertising. Probably I’m jealous of people who aren’t itching to leave their living rooms and go do something.

In any case my disinclination for remote work is clearly overdetermined. I’m aware that working remotely opens up access to psychoanalysis and therapy in ways that are extremely important, and from which many people absolutely benefit. But I’m worried about the implications and cultural impact of normalizing remote work: its imbrication with capitalist priorities (ease, comfort, time management, the seamlessness of tech: you can have work, and therapy, and porn, all on the same device!) and the cult of the family and the safe space of the home (to which the pandemic has returned us, as a culture, if we ever made it out). Psychoanalysis is meant to counter all that, and I do worry about the difficulty of exiting those incredibly seductive cultural imperatives when you’re surrounded by their accoutrements.

Most analysands come to analysis because the Oedipal home is much less comfortable than it bills itself to be. But it’s very easy to fall back in. You have to work to step out, and to me, the rituals of going to analysis—once a week, twice a week, every day, on the subway, thinking about what you’ll say on the way there or what you’ve said on the way back, sitting in the waiting room, looking at its books and trinkets, seeing your analyst emerge from within, dusting yourself off after, coat on, buttons hooked, what exactly just happened in there?—are a rehearsal of that separation. I have faith that psychoanalysis will do its work whatever the conditions. But I want my patients to come see me in my office, and see what happens."

• Emma Lieber, PhD
  Psychoanalyst

"I've kept my office the whole time. Many of the dilemmas about this time that seemed confusing at first seem to resolve themselves pretty easily - at least in my experience and I expect this will continue to be true.

I have found a first wave of vaccinated people big enough to open my office for one day a week to start. It looks like a second wave of vaccinated beings will present another full days worth of vaccinated citizens by mid May so by then i will go two days a week to my office.

At that point, I am sort of hoping to have a 50/50 split of in person and in office for most of the rest of this year. The clinical reasoning is as follows: I am lazy and would like to never go back to full time commuting again.

At first I imagined saying that all patients have a choice, at least through year's end, about coming in or staying remote. I think that will likely remain true and will likely result in my having the split between office and home I described above. In addition, this allows me to soften the superego jabs that complain that a theory based mainly on my being lazy is not acceptable but it is ok since about half of the patients will likely want to stay home too. Now that I articulate this reasoning it seems wrong in every way.

I think something is happening in society where any tendency to admit that we are making choices mainly because they are what we want, desire, prefer, can only go so far before the discussion shifts into some claim that one or the other choice (office vs. teletherapy) is better, good for the patient etc. So desire shifts into duty. Also why don’t people use the word “easy,” as in easy listening, take it easy etc. When did things being easy stop being allowed?

But I got a new therapist chair so that is nice.

As time goes by, I see that I am actually encouraging even the resistant patients to consider coming in for at least one time. To be clear, I am only seeing vaccinated people. I believe that if I strongly preferred office work, it would be acceptable to let people know that after some period of time (till the end of the year) that I do not consider remote therapy to be something I practice unless as necessary due to distance of the patient or pandemics. In other words, I do not see it as equivalent and clearly see it as less desirable than in person. That is just me and I know many great analysts practice by phone/remote and that's great. Everyone needs to find their own way in this. As I return, I do find I strongly prefer in person and do think I/we have perhaps underestimated the loss in losing in person presence and perhaps have overestimated the extent to which virtual therapy is equivalent to being in the same space together.

I wouldn't want to mystify or sentimentalize being in a room together, it just does seem important in many ways. I also am tired of things being poked in my ears and people saying "Can you hear me, " "I'll make myself invisible," and without warning conducting the session in the wild thus treating me to the sounds of wind attacking my ears alternating with the picture freezing every minute, the session unexpectedly being broadcast out of one of my 20 bluetooth devices and other such delights.

Also I don't think anything is about what it appears to be about. For example, at first in the pandemic everyone thought the thing to understand would be the pandemic itself or its conditions. But by and by again, it turned out that the pandemic was about racism. It still is. So I’m not sure that to get to the truth of teletherapy you can talk about teletherapy. I think it is likely about something else too and maybe even racism."

• Evan Malater, PhD, LCSW
  Psychoanalyst

"I've been seeing patients in person since October. I would have started seeing them earlier but I was booted from my old suite. We wore masks, windows open, filters. Now most of my patients are fully vaccinated and so am I. Some have not returned to in-person and have to be coaxed back. Others have moved away, and there's not much I can do about that. I would say at this point about 50-60% of my hours are in person."

• AF, PhD
  Psychotherapist & Psychoanalyst

[GREETING]

As of tomorrow, [DATE], I will begin the process of resuming in-person meetings for those who are fully vaccinated (i.e., one or both shots, depending on the vaccine, following the waiting period after the final shot). For fully vaccinated people, per CDC guidelines, we will be able to meet without wearing masks, though anyone coming in is welcome to wear a mask following their own preferences and concerns. Meetings for unvaccinated people (including those not yet eligible for vaccine) will continue to be remote.

To accommodate this, I will keep the window open in my office, will be running an air purifier continuously, and will be disinfecting surfaces through the day. If you elect to come in, I ask that you arrive at time for your appointment and not to use my waiting room. My office building requires masks in all the common areas, so please keep this in mind. [ADD IN ANY OTHER TYPES OF OFFICE BUILDING REQUIREMENTS]

Please let me know when you are ready to come in for our appointments so I can be prepared. If my or your circumstances change, we may have to revert to remote meetings on occasion.

Please understand that by electing to return, you assume the risk of transmitting infection to others and becoming sick yourself. Please do not come in if you show any of the symptoms that suggest infection (fever, cough, etc.). By returning, we agree that I will not be held responsible for any transmission of infection to you or people you interact with.

I look forward to welcoming you back to my office. Please write with any questions or concerns and please remember to write me at least 1-2 days before our next meeting if you would like to return to the office.

[END GREETING]

*** Compliments of Michael Garfinkle, PhD,
Clinical Psychologist & Psychoanalyst