In years to come, when we trace the development of our profession and consider the key factors that have influenced the way we work, and the way we think about our work, I suspect the COVID-19 pandemic will be seen as having forged a seismic, permanent change to the therapeutic landscape.
One change will be in the way we think about, and work with, the concept of the therapeutic frame. With the exception of those practitioners who had been used to regularly delivering therapy remotely via the internet and phone pre pandemic, in the past 12 months, the majority of us have had no choice but to forgo the customary, conventional frames on which we rely to create a container for our work: the arrival of our clients in our consulting room, at their allocated times; the subtle and sometimes not-so-subtle non-verbal signals we pick up from their body language as they take their seat, or lie on the couch; the physical presence of our bodies together within the space; the ways in which we move backwards and forwards, in small, sometimes imperceptible, ways, towards and away from each other; the space between expanding and contracting as we connect and disconnect; the shift onto our feet as the 50 minutes are up; the opening and closing of the door as the session ends.
These things 鈥� and many more I could mention besides (not least of which are our rituals around how payment is given and received) 鈥� are the familiar, tried-and-tested ways in which we create a frame for our work. They form the foundation for what we have most likely experienced in our own personal therapy as clients, and the basis on which we have been trained to work. We will have spent a lot of time paying careful consideration to how we have created this container 鈥� this sacred vessel within which the catalytic work of therapy can occur.
And how quickly we have all had to jettison these precious, treasured conditions in this time of lockdown, when meeting face to face with our clients has no longer been possible. How rapidly we have all had to learn to orientate and adjust to new and different therapeutic frames.
This frame has been literalised in the rectangular constraints of computer screens, which in turn contain the sub-frames that pop up within Zoom, Skype or whatever other communication platform we are meeting our clients within. A whole new set of rituals mediate the beginnings and endings of sessions, as we face our clients as disembodied, one-dimensional video images. Gone are the usual transitional spaces that mark, for both therapist and client, the arrival at, and departure from, sessions 鈥� the journey to and from our consulting room for our clients, the opportunities, perhaps, for us to converse with a passing colleague.
The therapeutic frame has also rapidly evolved to incorporate more 鈥榳alk and talk鈥� sessions than ever before. And we have had to think on our feet about how to do this safely and ethically while also ensuring that we continue to create a robust holding space for our clients.
As I said in my opening, the rapid evolutionary process we have all undergone in this last year will, I believe, change the therapeutic landscape forever. While many of us, therapists and clients alike, will be clamouring to get back into our consulting rooms as soon as we鈥檙e allowed to, many others will have adjusted to these new ways of working, and will be happy to continue seeking and delivering therapy remotely, or in hitherto less conventional ways.
While I have mostly seen myself as being in the former category, I鈥檓 also beginning to realise that most likely there is now no going back, wholesale, to the way things used to be, and that it might be wise to embrace and adapt to the changes the pandemic will render to our profession, in a spirit of opportunity rather than threat.
A century from now, I imagine the therapeutic frame will have further evolved in ways that are impossible for our imaginations to currently envisage. There is, after all, nothing permanent but change.
John Daniel, Editor privatepractice.editorial@bacp.co.uk
