Property,Materiality,Proximity: The Analytic Frame and In-Person Work

Abstract

In-person meeting offers psychologically usable material—signifiers that serve as day’s residue—that cannot be duplicated or substituted for in remote ways of working. Questions of materiality, the history and specificity of location, and bodily proximity all are key aspects of the psychoanalytic frame, as Bleger’s classic formulations attest. The COVID-19 pandemic has changed the choreography of engagement between analyst and patient: the ghostly dust in the frame enters the room. As Bleger says, with ghosts so rustled, nonprocess has a chance to become process. Two clinical examples highlight these points about materiality and in-person working. The final section of the paper extends Bleger’s description to tackle the perplexing situation of patients who hesitate to return to the office. Issues of “ghosting,” vanishing, disappearing are discussed, and linked to the constitutive absence that grounds any meaningfully structured presence. This constitutive absence is evoked by the prospect of the return to in-person analytic work. A final clinical example is used to illustrate this disturbing and irreducible fact about human interaction when two bodies are together in a room to discuss, over time, the life of one of the participants.

1

Psychoanalysts who have given serious thought to psychotherapeutic work undertaken via a technological medium such as the phone or computer, and have given, also, a sober reading of the extant literature, struggle to make universal claims about this work, and understandably so. Remote working in a variety of forms has been happening for decades, though certainly the COVID-19 pandemic has turbocharged its frequency (Zeavin 2021). There is by now a considerable literature within psychoanalysis regarding the overall effectiveness of teletherapy (the perhaps more neutral substitute term for remote working) and the ways in which it significantly differs, or not, from in-person sessions. For some patients the work is helpful and therapeutically effective, even profound, and no less potentially life changing than an in-person analysis (see Ehrlich 2019, Lemma 2017, and Scharff 2010, 2018 as representative examples). Yet, for others within our profession teletherapy is viewed as qualitatively different, and inferior, to in-person work (see Essig 2015; Russell 2018; Turkle, Essig, and Russell 2017). The debate has to do with questions of the irreducible impact of physical space, the proximity of bodies in that space, and the effects of the concrete materiality of the analytic setting as compared with the meanings the participants attribute to those same things. Ehrlich (2019), a powerful and thoughtful voice in this discussion, writes, “The analyst’s and patient’s attention to the meanings of the setting constitute an analysis, not the setting itself” (p. 271). Writers such Migone (2013), Svenson (2020), and Strosberg, Hook, and Leadem (2023) support Ehrlich’s basic claim; they stress that the same clinical concerns obtain whether the work is in-person or via a technological medium. For example, Migone observes,

What is important is not the fact that therapy is conducted with or without the Internet, but the theory we use to justify it, including most especially our ability and commitment to analyze the transferential and countertransferential reasons that lie behind the choice. Has perhaps the patient, or the analyst, in their preference for Internet psychotherapy, enacted a defense against some aspect of traditional therapy? And if this is the case, why? Contrariwise, has the choice for traditional therapy been made by one of the two parties or both as the expression of a resistance to an aspect of Internet psychotherapy that would have been possible or useful to investigate? And so on. (p. 294)

Contrary to this view is Turkle’s (in Turkle et al. 2017). She emphasizes the “specificity of presence” (p. 238), and asserts that “technology does not just change what we do, it changes who we are” (p. 239). Essig and Russell, important contributors to this conversation, agree with Turkle, and write that “screen relations are unwittingly serving the needs of technology entrepreneurs who want to replace therapists with apps and programs” (p. 235). “Screen relations” is a deflationary term, one meant to designate a compromised form of human engagement. Russell (2018) sees three basic problems with “screen relations”: (a) the absence of co-presence; (b) patients cannot “kiss or kick”—test, challenge in an embodied way—the analyst; and (c) the verbal mode predominates over other modes of communication. In the end, these are ontological claims regarding irreducible differences between in-person and technologically mediated psychoanalytic work.

The reasons analysts give for working remotely, likewise, are varied. Sometimes it is out of necessity: a virus intervenes, or a patient wishes to meet with an analyst who lives and works in another community and location. Or, commonly, it is out of cost and/or convenience: the patient’s commute to the analyst’s office is simply too long and the expense too great. Or, just as commonly, the analyst prefers working remotely because they can also be away in a safer and perhaps more pleasurable setting. What had begun in the first year of the COVID pandemic (2020) as a public and personal health necessity has for some clinicians, as these necessities recede, morphed into a more complex set of reasons for working remotely. Our clinical theory is evolving to take account of these changes in practice, as is often the case. Analysts such as Columbo (2022), González (2020), and Goldberg (2023) have each emphasized the portability of the analytic frame by locating its functions and efficacy within the analyst herself. “Framing activity” is work the analyst does in an ongoing, iterative way independent of material location, the concrete effects of which take a back seat to the centrality of this work.

In short, regarding either therapeutic outcome or the reasons given for working remotely, one encounters a variety of descriptions and claims that are evolving in ways that make it difficult to disentangle necessity, practical concerns, the freedom to work where some analysts wish to be at any given time, and the clinical understandings for what analysts are doing with their patients in such circumstances. And as I described in the prior paragraph, significant advances are being made in our understanding of the psychoanalytic frame and the framing activities of the analyst.

Everything I have to say in what follows sits against this contemporary backdrop, one that will not be going away.

This paper is about the materiality of location, the history of that materiality (which involves issues of property), and the proximity of mortal bodies meeting in closed spaces. I am interested in some of the ways in which the concrete setting of in-person meeting offers psychologically usable material—signifiers that serve as sources of day’s residue—that cannot be duplicated or substituted for in remote ways of working. ¹ Questions of materiality, the history and specificity of location, and bodily proximity all are key aspects—usually unspoken and inert—of the psychoanalytic frame. What does it mean to knock on a door? To enter into an enclosed space? To travel to that place for help? And what does it mean to not have to knock, enter, or travel? To, in other words, simply Zoom to your destination? In what follows aspects of the material, physical analytic frame are the landscape, the terrain, I want us to move through. Two clinical examples highlight the points I make about materiality and in-person working. Bleger’s (1967) classic formulations on the analytic frame assist me in this effort. Disruption, illness, and death in the life-space of the world—caused in our recent history by the COVID pandemic—force changes in the choreography of engagement between analyst and patient such that the ghostly dust in the frame enters the room. We can feel the frame’s fragility and the emotional, psychological, and practical work it takes to maintain it. As Bleger says, with ghosts so rustled, the inert frame has a chance to be experienced, grappled with, talked about. Bleger’s emphasis on the frame’s being invested with psychotic level fantasies, especially of an “agglutinated,” symbiotic link to the maternal body, retains the possibility of such investments entering into the psychoanalytic conversation—the hitherto unformulated can thereby take meaningful shape. Nonprocess has a chance to become process.

In the final sections of the paper, I try to get “behind” what Bleger described regarding the analytic frame to tackle the oft-encountered and perplexing situation of patients who hesitate about returning to the office (in the context of the relative safety of vaccines and boosters for the coronavirus and its variants). Here I am considering another, related aspect of what can get stirred up—evoked, aroused—by in-person meetings, in this case the prospect of returning to the office or clinic after a long absence. This part of the paper is as abstract as the earlier sections are concrete. When I say “get behind” Bleger’s notion of the frame, I mean the background conditions for anything meaningful to happen between two people at all. Here I try to give language to that absent realm of non-Being that conditions all meaningfully structured human engagement. Following Bleger’s language—though leaving behind his theory of the frame—I term this constitutive absence the nonprocess of living. Akin to Bion’s O and the Lacanian Real, this constitutive absence is, in the end, evoked inevitably by the prospect of the return to in-person analytic work. While Bleger alerts us to the fragility of the frame, here I am alerting us to the constitutive, background absence that haunts it. A final clinical example is used to illustrate this disturbing and irreducible fact about human interaction when two bodies are together in a room to discuss, over time, the life of one of the participants.

Though I have said that no convincing universal statements can be made about remote work, I will in fact be making one: meeting in person allows for aspects of the analytic frame to come alive that are not possible in teletherapy, and these aspects have to do with bodily movement and bodily danger, as well as deeper conditions of human existence, namely, nonexistence, and the possibility of disappearing tout court, not “virtually.” While some analysts have gestured toward these aspects of our work, none has, as far as I am aware, discussed them in any detail or explored their significance. As I’ve emphasized, I am not entering into the “good/bad” debate regarding remote forms of working psychoanalytically. I am, instead, speaking to background conditions to our working that often lay inert, unthought about, because the psychoanalytic frame remains undisturbed. With the option that many analysts now have to return to in-person work, these aspects of the frame have become more visible and raise, I believe, crucial questions about human engagement of most any kind, including psychoanalysis.

2

With the foregoing serving as a preamble, I begin with the following question: What does it mean to knock on a door? Let’s sit with this question for a moment or two and see, as analysts are known to say, what comes up. Like many aspects of the phenomenon of thinking in analysis, it’s not at all clear where one might stop, or how far back one might go in pondering the knock at the door question. But at least we’d go back to imagining someone—a person with a mortal body—traveling some distance to see someone else. I want to establish the obvious but perhaps taken for granted fact that people travel, often at great risk, to find someone at some distance for help of some kind. This seeking of help has been happening since humans could move their bodies in space—for, that is, hundreds of thousands of years. The traveling itself can take myriad forms, involving all kinds of risk or hardly none at all. And the purpose for which the traveling is undertaken informs everything else about it. If the weather is nasty, I might feel fine about aborting a trip to pick up the dry cleaning. On the other hand, if a loved one were in a medical crisis I would do whatever I could to get them to the emergency room as quickly as possible, no matter the risks involved. (If I were a political refugee, that is another kind of urgency, one that I have not had to consider personally.)

The door is a portal as well as a barrier. From the point of view of the visitor, it signifies the possibility of going inside, either because a person allows you in in some form, or you find a way in yourself. Maybe there’s a secret signal, or maybe you pick the lock. What is inside contains a certain mystery in that its contents are unknown until entry is granted or gained, one way or another. Consider the quiet excitement some feel as adults taking children trick or treating: we get to see inside places that otherwise are closed to us. Or think about the desperate hope that a traveler feels upon reaching a destination whose inhabitant has something, or is thought to have something, the traveler can’t do without—food perhaps, or fuel of some kind, or the offer of protection from imminent danger, or special knowledge that is imagined to be not only liberating but of absolute necessity for the visitor to have. “I went down,” the blues singer wails. “I went down to see the Gypsy woman about my baby. ’Cause we ain’t been gettin’ along the way we used to do.” ²

As for the proprietor, the inhabitant, that person who is inside the door, the door signifies privacy, protection, and an implicit ownership of the space into which the door is a portal. Context, of course, is everything. A simple sign above the door signals an entire way of conducting oneself in that space: if the sign says “Dry Cleaning,” that’s one thing. If it says “Psychoanalyst,” that’s quite a different thing. Consider this comment from Heinrich Racker (1957):

The analyst communicates certain associations of a personal nature even when he does not seem to do so. These communications might begin, one might say, with the plate on the front door that says Psychoanalyst or Doctor. What motive (in terms of the unconscious) would the analyst have for wanting to cure if it were not he that made the patient ill? In this way, the patient is already, simply by being a patient, the creditor, the accuser, the “superego” of the analyst; and the analyst is his debtor. p. 325)

Racker’s insight is part of the deep symbolic structure of analytic engagement in which desire, responsibility, and debt are at play. But this deep structure only obtains, only is alive and impactful, if the more concrete and prosaic features of arrival, entrance, and departure are well established. The analyst is an innkeeper, a proprietor who is in the business of greeting strangers, travelers in search of assistance and solace. As Racker suggests, the analyst is not any old proprietor (Wilson 2020).

Here it is telling that the words proper, property, proprietor, and propriety all come to us from the same etymological nidus—that which is “one’s own,” that which is “particular” or “special.” ³ Ownership is, as I said, implicit; if not actual ownership (which means legitimate title to property), there is at minimum something like possession: a clinical license to practice and the procurement of the space in which the practice occurs. Propriety involves an expected or right way of proceeding, of conducting oneself—conforming, that is, to conventionally accepted standards of behavior. What are we supposed to do? How are we supposed to act? What is psychoanalysis about such that sanctioned ways of proceeding are implied, demarcated, and reasonably expected by both parties?

So the traveler has arrived, and knocks at the door to signal said arrival. For the psychoanalyst, this knocking takes a variety of forms: a signal light, a doorbell, a knock, a text, or the sounds of an outer door opening and closing. Maybe a dog barks as a cooccurring event. Whichever way the signal happens, the patient is here. And after that, the patient speaks; they give an account of themselves and their travels through life up to this point in time, this point of meeting.

What I’ve just described are the conditions—the essential elements—of psychoanalytic engagement. We might be tempted to see this structure of engagement as an ossified relic of a quickly receding past, a Western bourgeois professional two-step that began in the 19th century, saw its peak in the 20th, and is now being superseded, if not entirely replaced, by teletherapy. This replacement, however partial or complete, may be true in a practical sense, but it can’t be true regarding the area of concern I am exploring in this paper: the psychoanalytic implications involved in the built environment of clinical engagement, in which bodies travel through space and time for help and encounter a series of risks and rewards that remote working cannot replicate. Behind this space, and obliquely illuminating it through shadows and darkness, is an absence that conditions the usually available tools of our work: meaning, representation, and more broadly, the structured world in which we live.

3

I want to consider in more detail the question of material location. We have to be somewhere to do our work, even if some analysts are now, for the most part, working remotely. That somewhere has a GPS location, it has a parcel number, and is probably in a building of some kind that sits on a piece of land that is owned by someone. The building—a clinic, hospital, or private office—and the land on which it sits have a history, obviously, though this fact is almost never considered or thought about, beyond the knowledge of who our employer or landlord is, or whom we bought the building from, or the details of our subletting arrangement. Why would we consider these questions about the material origins of our workspace? We hear from patients about the waiting room, or features of our offices—lighting, temperature, furniture, and so on. But rarely do we consider the deep backstory of how the building came to be in the first place. And if we did consider this question, how far back would we go? At some point in time or other, something was either claimed or stolen, some advantage was taken, some life was lost. Whether at gunpoint or through legislation, land was occupied, surveyed, and sold to the advantage, largely, of white people with means, opportunity, or both. I’m gesturing here to the important work of Daniel Butler, and his paper, “Racialized Bodies and the Violence of the Setting” (Butler 2019), in which he writes, “The White imaginary deposits its phantom world (i.e., the violence of slavery and settler colonialism) into the setting, and this deposit is further entrenched by projecting racist phantasies onto Black bodies” (p. 148). All of this deeper history lurks within the analytic frame, and as I will argue later in this paper, has less impact as content—the settler colonial history of the land and its divisions and distributions, for example—and far more as a signifier of change itself, of fragility itself, of the contingencies of power and accident, of emergence and disappearance, of life, and of death.

In summary, where many of us do our work, where our practicing analysis takes place, operates within a set of conditions that have these links to race and history and the economics of class, links that are silent background conditions for our work to happen at all. All kinds of talk can enter into analytic work precisely because the setting is not being physically invaded, foreclosed on, or otherwise compromised. ⁴

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But, even in the seemingly safe confines of the analyst’s office—private, quiet, and off the beaten path—safety itself may be as much fantasy as it is a taken-for-granted reality. As I will now describe with my patient Thomas, I came to understand my own assumptions about safety and location, assumptions that amounted to my own need for an incomplete and in some ways false picture of the material location where I work.

Thomas ⁵ is white, married, a father, and a successful professional in a field in which his judgment and actions are often under attack. He is something of a “born-again” Christian—not evangelical, he is quick to point out. “I’m re-finding,” he tells me, “my Catholic upbringing.” Part of his Christianity is his passionate support for Israel’s right to exist as a Jewish state. He is also a highly trained firearms expert, and is well versed in knife and “empty-hand” combat. He told me at the beginning of our work that he automatically canvasses any new location he is in for exit strategies and for any objects that he may be able to use as weapons should he need to do so. He would chide me from time to time about what he presumed was my liberal-leaning naivete:

You think it’s so safe around here, practicing on this quiet, fancy street. Police logs and crime statistics show that right now, this very minute, 10 to 20 crimes are being committed within a mile of this office. Three or four of them at minimum are violent crimes.

There are many other features of this case I could mention, but my main focus here is on the question of location, both material and psychic, where we are and where, imaginatively, we can go or find ourselves going. And to questions of safety. Thomas, clearly, wants me to know that no place is safe.

My approach to Thomas and his struggles was superficially no different than with any other patient: I was curious about and interested in his endeavors, whether it be his marriage and children, his job, his political perspectives, or his deep involvement with firearms and questions of safety. I learned much about all of these domains of Thomas’s life. He worried that I felt “repulsed” by him and that I privately took issue with his intensely pro-Zionist stance: “At best, you just tolerate me,” he said. There was also—and at times this was made explicit—a worrisome, if fleeting, feeling in the room. As I said, Thomas told me that he had canvassed my office for “weapons” (i.e., heavy objects) the first time he entered it.

My conscious transference to Thomas was, in retrospect and in a way that I will describe in a moment, perhaps too unconflicted. I did often ask myself, as he would wonder about my feelings of repulsion for him, if I did at all feel repulsed? Or did I feel afraid? What about his, from my personal perspective, brutal view of the Palestinian people and their right to self-determination? ⁶ As his analyst I was open to all possibilities and curious about whatever he was talking about or struggling with. As a citizen, I was perhaps less charitable toward him. I was, also, less aware of these possible feelings and dispositions until I had the following dream:

I am in the West Bank, looking for kitchen appliances. That is the “reason” why I am there, though there are no appliances to be found. Instead, I am in a concrete, modest building, with dusty white walls, a bare cement floor with little if any furniture. I am loosely part of a tourist group; we are white, a mix of Jews and Christians, and pro-Israel. But something ominous is afoot. There are “Palestinian terrorists” in military garb with assault rifles over their shoulders standing outside and in a doorway. We’re in potential danger, and I try to warn the people I am with that we have to leave immediately: “We have to get out of here! Now! Let’s go!” The chaotic scene becomes more focused and my visual field narrows as I or we run out of the building. It now seems safe, but quickly I realize it is not. So I pick up my pace, and implore others to keep running, to keep escaping. Then things change: I am driving a small car on a highway overpass, speeding to get out of the West Bank. Now I have a choice to make. I either veer left and head back to the West Bank and face what seems to be certain death, or veer right and make it safely to Jerusalem. Since I don’t know the roads and this decision is upon me all at once, I fear I will turn left and be in danger again. But I lean to the right, nudge the steering wheel in that direction, and know I will make it to safety. Then I wake up.

There are an infinite number of ways that the analyst, through the course of an analysis, changes, is transformed, finding himself in a new place in relation to himself and his patient. Such changes and transformations have been well described in our literature. Here, with this dream, I am fully living in my patient’s world as I am dreaming that world. And in so dreaming it, I allow myself to feel, in experiential form, the mystery of human drama, the reality of conflict, and the ubiquity of fear. But most important, my dreaming and remembering the dreaming both demonstrate and create a new and emerging subjective/emotional/analytic position in relation to my patient Thomas, in relation to his specific human drama and conflict, to his world and his life. In this dream I see my own “dream work,” in that I have found myself in a place I didn’t know I could inhabit but now did: that place not only of the politically incorrect, but on that knife’s edge of danger and fear in the face of the threat of violence and potential death. Within this dream scene I fully buy into the sense of danger and potential harm that Thomas lives with every waking moment. I also more thoroughly appreciate that I feel a muted form of this danger, captured in the dream, with Thomas in my office, as we are together talking. I am not only afraid for him from his first-person position, I am also afraid of him from mine. This is of great analytic importance: my more consciously engaging with the domain of fear within the unfolding of our relationship will help me help him be more open to being with that fear as it shows itself in the now-and-the-next of our work. In sum, my analytic position in relation to Thomas is changed, or better is changing as I simultaneously appreciate, après-coup, that I had been less charitable, more censorious toward him and more fearful about him than I had let myself know, and, through this dream’s proleptic force, that I am ever more Thomas’s analyst, and less a distanced and removed private citizen (with proclivities and opinions and the like).

What would Thomas’s analysis have looked like if we were meeting only remotely? If he never, or rarely, met with me in person? It seems to me obvious that the whole question of safety that was so central to our work together would have taken a far less severe turn. If we’re not meeting in person, then he’s not canvassing my office for weapons and figuring out exits, and he’s not telling me about those things while lying on a couch with me sitting only a few feet away from him. For my part, if we’re meeting remotely I’m not feeling a particular kind of worry about safety, or sensing my bodily vulnerability, let alone noticing the various heavy objects in the room that he or I could use as weapons. Would I have had my West Bank dream, which helped me in a singular way to better help Thomas? That question is impossible to answer with any certainty, but I am doubtful that I would have. What about Thomas’s traveling each day to see me, over highways and surface streets, the land and the built spaces on it that themselves have a complex history and a dynamic living presence? This movement—his movement—is itself meaningful. I’m contrasting this kind of bodily movement through space and time with Zoom sessions, in which, as the word implies, without moving at all we travel magically through space and over ground and instantly arrive at our destination. ⁷

4

José Bleger (1967), in his justly admired paper “Psychoanalysis of the Psychoanalytic Frame,” helps us see that these ultimately fragile and transitory features of the material setting and the choreography of professional engagement are irreducibly part of the frame. These background conditions of analytic work Bleger calls “nonprocess,” a “set of constants” (p. 511): bodily movement and traveling, arriving, entering, speaking, leaving, scheduling, paying, and the like. All of this, usually and for the most part, is in the background, taken for granted; it is nonprocess that allows the analytic work, the “process,” to unfold. “There is no awareness,” Bleger writes, “of what is always present” (p. 512). Importantly, this “set of constants” is the essence of what makes an institution. That definition, in and of itself, is notable—an institution such as a psychiatric hospital, or a university, or a psychoanalytic center of learning is established to do specific things that themselves usually are not questioned: things such as the diagnosis and treatment mental disorders, or the teaching of a set of classes organized around an academic calendar. A psychoanalyst’s practice setting is its own form of institution in Bleger’s sense of the term, imbued with values, inheritances, and ideologies (Columbo 2022). Bleger links the integrity of individual identity (the ego, in his lexicon) to institutional affiliation. If the integrity of the institution is solid, the integrity of the individual involved with that institution’s practices and ongoing functioning will also be solid, or will be operating from a solid foundation. The frame itself only comes into view through a break in its structure, a tear in its fabric (e.g., a missed appointment or cancellation, or a sudden collective lockdown because a virus is on the loose). Once the assumed, the taken for granted, is questioned, then the legitimacy of the institution is questioned. The key move in Bleger’s argument is the following: “We must accept that institutions and the frame always make up a ‘ghost world,’ that of the most primitive and undifferentiated organization” (p. 512). Regarding psychoanalysis, Bleger says that psychotic level confusion—a “symbiosis” with the analyst/mother—lurks within the walls of the analytic frame. It stays there, undisturbed, unless the frame is shaken, one way or another. There are many ways the frame can be shaken, and there are just as many kinds of ghosts that can emerge from those seemingly inert walls.

Importantly, the picture that Bleger paints is one of the hopeful recouping, in symbolic form, of that which is hidden, diffuse, undifferentiated, hitherto symbiotic, the very grounding upon which human living takes place. Nonprocess is always, potentially, “figurable” (Botella and Botella 2005); it can be given verbal shape and so come into something workable within the flow of the analytic process. In fact, a close reading of Bleger’s paper makes clear that he is talking about a conflict that emerges between the analyst’s frame and the patient’s frame; the latter is the earliest formed constructions, expectations, and gratifications about the world that Bleger (1967) calls “the patient’s most primitive ‘family institution’” (p. 518).

As Daniel Butler (2019) writes in discussing Marion Milner’s notion of “minding the gap” in the analytic setting, “the gap in which one loses oneself is tolerable and amenable to symbolization; [but] if [the setting] is not safe enough, the gap can psyche-somatically annihilate” (p. 152). I will return to this point in a bit, but want to mark it now—this ever present potential for representation of the so-called ghost world, as well as the contrary outcome, the possibility of psychic annihilation should symbolic tools fail, and the absence that conditions those tools to count as symbolic at all.

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With most of my patients, I was back in my office in June 2021. We had all been vaccinated. At first we wore masks and then, after a few weeks, we did not. Soon after, in August 2021, the Delta variant became a sudden and worrisome concern, and going back to wearing masks was a nonevent for nearly every one of my patients. We wore them. This change made sense to most people I saw in my office and to me. But with one patient, Carl, ⁸ the mask wearing signified something quite different from a commonsense safety measure. On the contrary, it meant something intensely personal between us: that I felt in great danger and he was the sole object of my fear. Carl’s concern that I hated him, really wanted to be done with him, had been around and spoken about for many years. This fear took various guises. Sometimes he would ask, “Is it torture for you to see me?” He was a schoolteacher, and often talked about how much he “hated” (his word) dealing with needy and demanding parents. “I know,” he would say with the utmost certainty, “that’s how you feel about dealing with me.” With the Delta variant surge and my wanting to resume mask wearing—which I did not handle as thoughtfully as I should have—for Carl this meant, to put it simply, that I couldn’t stand him. Full stop. The sources of his fear of radical, absolute abandonment go deep into his history. From time to time, he and I had conflict about how we assessed risk, and the risk of giving or getting the virus. In fact, this difference in risk assessment signified to Carl that I was not thinking rationally, itself a source of profound anxiety for him. What I want to emphasize in this case is how structured Carl’s fears were; his suffering, brought about by a significant change in the frame, was not, in this case, “the most primitive and undifferentiated organization.” In Bleger’s terms, the ghost that emerged with the using of masks for the second time had a phantasmatic structure: it was the ghost of utter rejection by an irrational analyst, and that the patient was fundamentally and abjectly alone, discarded, unworthy of any meaningful connections to other people, especially to me.

Notice, again, that without the proximity and detailed immediacy of in-person meeting, and more specifically the signification, for Carl, of an N-95 mask, the intensity and force of his profound fear of his “toxicity” would likely have remained inert, resting quietly within the walls of a set of constants, of “nonprocess.” In this particular case, nonprocess has a chance to become part of the unfolding analytic process by way of the conflict between the patient’s expectations and my own. The hitherto lost world of the inert frame, the opacity of trauma that was lodged within the frame, is no longer lost and no longer opaque. “Frame deposits” can always be excavated or in some way recouped from the rubble of the now shaken frame. This is another way to give figurative language to aspects of Bleger’s nonprocess. Much of the time a frame disturbance then has a chance to become part of the unfolding analytic project.

But the COVID pandemic and therapists’ return to in-person work show us something else that otherwise would have remained entirely hidden and undisclosed, which is where I now turn.

5

I have argued that in-person meetings—because of the proximity and intimacy of two bodies meeting in a closed space—inevitably summon basic concerns about safety and danger that simply do not obtain when intensive, ongoing clinical work takes place remotely. What I’m going to explore and explain next is far trickier to capture than what I have described thus far: this is what I call, adopting Bleger’s language, the nonprocess of living itself. By conceptual definition, I am pointing toward not an, but the unrepresentable realm—absence, non-Being—that conditions all representations, all binaries, all symbolically mediated experience (including all of the “framing functions” the analyst facilitates). We are in the realm of Bion’s O and the Lacanian Real, areas of existence that by definition resist symbolization; they are the lack, the in-between, the unrepresentable infinite space within which presence manifests. ⁹ As a negative ontological space, all we have at our experiential disposal, in refracted form, are traces, markings, stand-ins, for it—hidden foldings within the strands of life (Ruti 2012). Ready-to-hand objects that can be weaponized (as in the case of Thomas) and N-95 masks (as in the case of Carl) are palpable—they take up space and signify meanings and possible uses for them as objects in the world. Absence, lack, non-Being do not take up space and signify meanings or meaningful use. Presences, objects, thoughts, feelings and fantasies all emerge from this place of timeless silence. One indication of our registration of this realm is the tonal, baseline alertness with which we are biologically endowed and that is operating at every waking moment no matter what we are doing. On the same level as breathing, this alertness, this baseline vigilance signals our bodily awareness of this other realm, that place in which we don’t exist.

As a concrete way into these traces and markings and stand-ins, let’s consider what unfolded for me (and I believe many analysts) with the prospect of patients returning to my office to resume in-person work: it proved to be anything but a straightforward decision for several of them. (Carl was a notable exception: He always wanted to meet in person, even prior to vaccines’ being available.) Here are some things patients said when thinking about returning to in-person work:

When I click the Zoom link and you appear, that feels exciting. And I can have my dog in my lap too. It feels sketchy somehow to give all of this up [she gestures around her apartment] and come to your office again.

I like my house. I love being around my things. They feel familiar and safe.

I can’t deal with seeing you again in that space [my office]. It’s far too quiet.

I like the phone. I like that I can hear you breathing quietly between the words we say to each other.

Leaving my bedroom feels really weird and oddly scary.

My car is pretty damn comfortable. I have a place to park that’s private, and I have my coffee. I can look at the hills as we talk. I can hear the wind. It’s so expansive here, and so enclosed there.

The stark difference between the computer and seeing you in person . . . makes the transition from outside your office to inside it even more intense and diffusing, as if I’m in outer space pushing objects that float aimlessly.

Adam Phillips once said, “Psychoanalysis is about what two people say to each other if they agree not to have sex” (Bersani and Phillips 2008, p. 1). In addition to Phillips’s comment, which speaks to various incestuous dangers and potential trauma of in-person meeting, what feels perhaps more relevant here is that psychoanalysis is that human experience in which two people spend a lot of time together and don’t die, they don’t vanish into the silent emptiness between movement and sound, between living itself and the nonliving that is living’s ultimate background condition. “It’s far too quiet.” It is reasonable to wonder if this aspect of analytic work is one that Bleger gestures toward regarding the frame, especially when the frame is, as he said, part of a painfully poignant, perhaps intolerably real, “ghost world.” While Bleger did link the psychoanalytic frame and bodily coherence (and implicitly the body’s vulnerability), he did not consider its disappearance, let alone the silent emptiness that conditions all presence. But it’s clear that ghosts come from some other place that is inaccessible to the living; they inhabit a world of the dead come back to the living, and evoke the ever present possibility of vanishing, disappearance, of life ending. This feature of Being—namely, the ever present background of non-Being—is figured in the ways in which a click of the keyboard can make someone appear or disappear. Tellingly, “ghosting” has moved into our common lexicon to mean total disappearance: “I never heard from them again. They just vanished.”

One could reasonably surmise that this baseline, vagally mediated fear is about control—vigilance, after all, is a staying awake and keeping careful watch for whatever danger might come our way. Or that it is about projected aggression, the other side of vigilance. But with vigilance and aggression we have a binary that is rudimentarily structured. This level of analysis is, to my mind, not basic enough; it is already too organized. At the most basic level, the question of control or lack thereof has to do with vanishing, with disappearing. That is, there is a field of non-Being—the eternally inert frame—in which life and human meaning as such come into being. There are reasons humans mark the emergence of a new life into the world with what we call a birth certificate. The same reasons obtain when someone dies: there is a death certificate. These pieces of paper represent the emergence or disappearance of a human being. It is at this level that the return to in-person meeting has stirred up the specter of ghosts—those who have vanished, and those of us that will.

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Lydia ¹⁰ was nearing the end of a long analysis. But during the first year of the pandemic, in which we were meeting only remotely, talk of what seemed to be the final months of our work was put on hold. Once vaccines were accessible we resumed our discussion of ending her analysis. Lydia had come to see me because she was emotionally devastated by the breakup of a long-term romantic relationship that she believed she had wanted, only to find herself utterly bereft after it ended. Later she went through a midlife career change. In our work, I found Lydia to be funny and engaging, by turns thoughtful and sad, but also, most important, oddly removed in a way that is hard to describe. Mostly I noticed this remove in registering my own removal—an unusual complacency in myself—a kind of letting her alone, not challenging her in ways that I wouldn’t hesitate to do with most other patients. Over time it came to light that much of her problems with her breakup were related to dalliances with other men, none emotionally serious, but undertaken in a casual, dissociated way, hidden from her partner. She and I developed a language describing this world of encounters as the “second dimension,” “another place,” and the like.

Lydia and I met in person for most of the analysis, but during the pandemic our sessions followed public health guidelines. After getting vaccinated, she and I set a termination date, one that would allow us to meet for a few months in person again before ending our work. But over those months she was without a car, so traveling to my office was something of a burden. We’d been talking by phone. She was the patient who said my office is so eerily quiet.

At various points during those months I said to her, “I think it’s important that we meet, at least some of the time, in person.”

Typically, she replied, “I think the phone is fine. I far prefer it to Zoom. In fact, I think that, in terms of analytic progress, much has happened that has been helpful to me since we’ve gone to the phone full time.”

I’d heard her say variations on this theme before, and she meant the ways in which she can lose herself in fantasy, mostly by planning trips she can’t afford or playing various word-games online. “You’ve helped me keep myself tethered to my present reality,” she told me. “I leave the ground less often. I fly away and into that other dimension less frequently. It’s why I can live with my boyfriend and finish preparing for my orals.”

It is true, I thought. She has made significant changes in her life since we began working together and especially so lately. Yet, with all that said, I felt Lydia to be at an uncomfortable distance from me, especially in light of our termination date quickly approaching. I asked her, “So your idea is to meet by phone until we end the analysis?”

“Yes.”

I said a variety of things to her that come under the heading of “expected analytic interventions”: “You’re struggling with our ending, and seem to be dealing with it, in part, by keeping your distance from me.” Or, “There’s something in you that feels the need to devalue our work, to make ending not that big of a deal.” And the like. After discussing various ways she could get to my office—Lyft or Uber (“I hate the gig economy”), riding a bike (“I haven’t ridden a bike since middle school. I really don’t know how, especially on city streets”), or taking the bus (“that would take too long”)—I said, “You seem to want something for nothing. At no cost to you. We’ll just end via the phone and that’s it.” She thought about this for a while, and bristled some, but only a little, and then disagreed. “I’m working very hard right now, both in analysis and to finish up my degree. It’s working for me.”

Then, feeling that I had exhausted every interpretive intervention I could think of, I said to her directly, spontaneously, “Well, I’ll just say: I don’t like it.”

That statement—“I don’t like it”—hit the nail directly on the head. She replied:

“Oh. I see. Okay. All that other stuff you were saying, that I don’t value the work we’ve done, it was so untrue that it felt you had gone missing. With the ‘I don’t like it,’ it feels like you’re back. I can walk to your office.”

She said this without hesitation. “I can do that on Wednesday. Shouldn’t take more than 45 minutes.”

On the following Wednesday she comes in and lies down on the couch:

“I loved being at home,” she says. “I feel very comfortable and safe there. Here I’m much more exposed. Open to any possible harm. A lot of that I can think through and talk with you about. But it’s the silence, the interminable quiet, that freaks me out.” And she starts to cry.

“You’ve mentioned the quiet before. What do you mean?”

“Not that you’re quiet, but that ‘it’s’ quiet. As if the sound-proofing is too good. It’s like darkness, the absence of light. As if sound has been sucked into a vacuum and nothing is left.”

“As if I’ve been sucked away too?” I’m struggling to grasp what she is trying to say.

“I don’t know. Somehow that being here again with you makes me worried about when I won’t be here anymore, and that my thoughts won’t have a place to go. Who will remember what I say? I know that if something comes up I can come back, but how do I know that you’ll be here, or anywhere? When you said, ‘I don’t like it’, somehow you came into focus as clearly existing. I feel lame saying it but everything was clarified in that moment. When I was at home I didn’t have to deal with this feeling—but it feels like a truth with a capital T—that everything can vanish in an instant.”

I say, “The earth can swallow us up and we’re gone.”

“Yes.”

6

Knocking on a door to announce one’s arrival is of a different order of experience from signing on to a Zoom call. There is a good reason the latter is labeled “virtual.” My argument in this paper has been about what I believe is missing from remote work on a constitutive, foundational level, which means it can’t be a part of it: This is the ground floor of the material world and its objects in space, the human body, and what happens at this most basic level when two people meet for intensive psychotherapy in a specific location that itself has a history. Histories, let us remember, are inherently contingent and temporary in the sense that they are never fixed: they evolve, spiral and recur, and evolve some more.

The fragility of the analytic frame is palpable to us, and has been long before the COVID pandemic changed nearly everything about how most analysts work. The factors that contribute to this fragility are well known, and in an important sense the history of psychoanalytic clinical theory has developed precisely to account for these factors, in order, as Bleger says, to allow nonprocess to enter into process, to enter into our overtly symbolically mediated analytic conversation with our patients. The frame’s fragility is why it takes human labor, emotional and physical, to maintain it by carefully attending to it. And in the background of this human meaning-making and intimate engagement is nonprocess in the most fundamental sense: the absence that not only conditions the analytic frame but also haunts it, as silence grounds sound, and death sits within the folds of life—all of which the return to the office, and in-person work more generally, allow us to get a glimpse of, see traces of out of the corner of our eye, if only for a moment or two.