I didn’t think you were listening. Some Reflections on Online Setting and Patient Proxy in the Remote Clinical Relationship

Abstract

Background: The limitations imposed by the SARS-CoV-2 pandemic on social relatedness (use of Personal Protective Equipment, interpersonal distancing, suspension of face-to-face activities, etc.) forced psychologists and psychotherapists to suspend face-to-face clinical activity for several months. The use of video calls (e.g., WhatsApp, Skype) and videoconferencing (e.g., Zoom, Meet) was the only way to avoid the interruption of psychotherapy and psychological counselling. However, the shift from offline to online psychotherapeutic settings has raised interesting theoretical and technical questions about how to consider the frame of clinical intervention. This article aims to contribute to the reflection on the characteristics of the online setting (videoconference) and its differences and specificities compared to the traditional setting. Methods: The article proposes a clinical case treated in an online psychotherapeutic setting. The intervention was carried out in the context of a counseling and psychological support service of an Italian university. Results: After a brief presentation of the case - a young adult with anxiety symptoms - the article describes a relational episode that occurred during a video-call interview (Skype). On the one hand, the episode highlights the characteristics of the patient and, on the other, how the online setting facilitated the expression of the patient's relational patterns. Conclusions: The case refers to a young adult who seems to develop interpersonal relationships based on presence/absence. The others (parents, partners) are always described as lacking something and, therefore, in some way, "absent". The patient himself is described as lacking something (e.g. masculinity) and shows himself unable to be fully present in situations. However, the theme of presence/absence also characterizes the online psychotherapeutic setting: presence is disembodied, lacking physicality. On the one hand, the clinical case highlights the need to understand the characteristics of the online setting better, and on the other hand, the importance of always keeping frame and process connected. It is fundamental to remember that what happens in the setting and is always an integral part of the clinical intervention.

Keywords

• online setting
• psychotherapy
• clinical psychology.