To deal with the Covid 19 pandemic, health protection measures require changes to our clinical practices. Faced up with the unprecedented nature of this situation, the liberal psychotherapist is led to rethink some aspects of the framework of his practice in order to preserve the thread of the transferential relationship. The authors develop a clinical reflection on the clinical setting in a pandemic period by exploring in particular the dynamics of telephone sessions. For telephone interviews, the question of the sound envelope is central, in particular regarding the psychic function of silence. We choose to illustrate our point with short vignettes than by relying on long-term clinical cases, more likely to represent the variety of new clinical situations encountered and the questions that accompany them. This article introduces his point by recounting the plague epidemic in ancient Greece to show the impact of the environment on humans and its collective fantasy implications. Being faced up with death, contamination, the invisible enemy brings out a palpable concern. It is indeed quite remarkable that these same reactions and concerns in front of death caused by the pandemic match with what is related by Thucydides who survived the plague, which affected Athens during the Peloponnesian War. In another context, Winnicott highlights the place and importance of the therapeutic environment. It is both a question of adjusting the framework according to the context while maintaining certain intangible aspects representing the permanence of the link and its framework. A framework cannot exist without being kept, which is equivalent to thinking of the framework above all as an internal framework, questioning the clinician about what he values and what he makes sense in his practice. In the current context, these questions arise from the perspective of a certain flexibility, depending on the human context (child, adolescent, consultations, etc.) or external context (crisis linked to a virus, etc.) showing that it is more than never question of exercising on a case-by-case basis, taking into account changes in the environment. The initial observation during this period of confinement concerns the fact that some patients contact a therapist for the first time by telephone and wish to initiate psychotherapy (during this period) when they explain that such an initiative was not possible. Despite the difficulties already encountered in the past. But there is also the opposite case: patients who have no intention of continuing the work already started during this time. Thus, faced up with the injunction of confinement, they show themselves in the psychic impossibility of following the treatment by other means such as, for example, telephone sessions. In this perspective, the silence on the phone takes on a different tone; silence reveals itself to be a source of greater anxiety than in presence: the presence of bodies, of its movements perceptible as imperceptible, of a gesture that carries or accompanies the senses, breathing, the visual context of the office and of its “decor”, represent as many essential elements in the usual capacity of the frame; in the absence of these basic sensory elements, silence can be experienced as a void, or even a gap in the bond, opening Pandora’s box of paranoid fantasies acting unconsciously. If silence is representative of the whole framework, it promotes in this context the partialization of the clinician’s body reduced to one ear and not to a whole body. Here, it is the change of framework that mobilizes the difference, established by Mr. Klein, between the partial and total object; this circumstance neo-framework could therefore call for regressive movements, undoing the silence of its symbolic function when the bodies are present.

Houssier F, Christaki A, Vlachopoulou X. Séances par téléphone dans le contexte du Covid-19 : le cadre et ses limites [Phone sessions in Covid-19 environment: The frame and his limits]. Ann Med Psychol (Paris). 2020 Sep;178(7):738-742. French. doi: 10.1016/j.amp.2020.06.002. Epub 2020 Jun 5. PMID: 32836301; PMCID: PMC7274568.