REFRAMED

“I was thinking to myself, I can’t wait to tell them. They’re going to be so excited!” Or maybe the patient didn’t say excited—maybe they used a different word. I can’t exactly remember because my mind got stuck on them/they’re. It took a moment before I realized the patient was referring to me. They referenced me not as her/she but them/they. My preferred pronouns. I was moved, for a moment, out of the shared space of the session, out of the patient’s experience and into my own. Something caught in my throat, my eyes watered just a fraction, and my heart skipped a beat. I felt fear; I felt gratitude. I slowly settled back into attunement with my patient, and though they remained on the screen, many miles away, I felt closer to them than before. 

When I see patients, my “name tag” on virtual platforms includes my pronouns in parentheses: (they/she), out in the open, for all patients to see. And yet, how strange to be seen. Something feels uncomfortable about it that makes me believe it’s imperative.

I started in private practice for the first time last summer, August 2020. My first job post-postdoc, post-license, midpandemic. I decided to be out in my bio on the group practice website, stating for all to see that I am a queer clinician who loves working with the queer community. It took me hours to write. I went so far as to submit a draft with no mention of my identity whatsoever, only to retract it immediately. As I typed, backspaced, typed, backspaced, the task began to feel like a reenactment. How badly I want, have always wanted, to be fully seen in that regard, and how often I have defensively moved away. A part of me holds great shame about that, and it’s hard to write. As much as I’ve wanted to be “out and proud,” more of my life has looked like “out and ambivalent.”

And yet, a still bigger part of me knows I’m not alone in this, as a queer person and as a psychodynamic/analytic clinician specifically. I know that my ambivalence comes not only from the bumps along the road of my own identity development but from a conflict within our field as a whole. I mean, of course, there is harm historically and currently inflicted by psychologists on queer folx. We (psychologists) have ostracized us (queer folx) as mentally ill and morally corrupt; we (psychologists) have caused irreparable damage to us (queer folx) via conversion therapy. Again, these pronouns are intentional and important—I am both subject and object here. 

But I mean more than this. I think a particular kind of person becomes a dynamic clinician or an analyst. This particular kind of person might understand what I mean when I name both fear and gratitude in the same moment of being seen head-on, a therapist in the headlights. Perhaps they understand the split intimacy of knowing the deepest parts of a person, their patient—and in some ways being known quite profoundly in return—while ultimately remaining unknown, unseen, the blank screen. For no matter how we may eschew the traditional analytic notions of neutrality in favor of relational, intersubjective ways of being and feeling with the patient, there is a boundary. There is a power dynamic. There is an imbalance. And it keeps us safe. It keeps us—or parts of us, at least—utterly unknown to the person sitting across from us (or the person sitting in front of a screen looking at a projection of us). 

Part of that is so painful. Is there one among us who hasn’t ever wished for some part of their self to be seen by their patient, freed from the frame? Another part of that, we must admit, is a huge relief. We can sidestep; we can evade; we can avoid feeling stuck in the headlights of intimacy. Someone once told me when I was a kid that we pursue a career in what we feel most deeply lacking. Yikes. There’s a lot I disagree with there, but I’m trying to hold on to the grain of truth: being known for all of who I am has always been hard. And I imagine other folx who find themselves in this Room may join with me here.

Now we see patients amid a pandemic, violence, societal upheaval. Everything feels blasted apart—literally we were all torn apart from each other by mandates for quarantine and social distancing. And yes, clinical work feels so distanced over the internet. We are so very far away from our patients. And also, we’ve never been closer. 

There’s a way in which everything feels more personal, more human to human, than it ever has (at least for me, in my short time practicing). We are sitting in the same mud, swimming in the same water, trying to stay afloat and acclimate, together. The safety of the typical frame has collapsed, and we’re being truly seen as never before. This means everything from disclosures made of practical necessity (pets and babies making unplanned guest appearances on screen) to a heightened transparency of feeling through the same phenomenon with patients in the same moment (no way to fall back on the eternal advice of “doing our own processing first”). 

It feels uncomfortable in the way that makes me believe it’s imperative. Over the last year plus, we have been forced to face head-on what we previously worked to evade. We have been subjected to a staggering loss of life wrought by an administration that refused to face reality. Centuries of racism have erupted in renewed violence, injustice, terrorism. We have been forced by technology to witness the extremes of the racism that we, white people, turn away from daily. We can’t not see it anymore—though, unfortunately, there are many of us who still try. There is a time and a place for analytic neutrality, but perhaps this sociopolitical moment is not it. 

I didn’t make the conscious connection at the time, but I see it now. I don’t know if my choice to come out at work would have happened in the same way if it hadn’t been for the last year. It felt imperative to come out to face the discomfort that comes from naming a reality that not everyone will accept. 

It is not lost on me that clinicians of color face this discomfort every single day; it is impossible to not disclose the color of one’s skin. It is not my intention to equate sexuality with race and ethnicity but only to name that it is an incredible privilege that I have the choice of disclosure at all. It is also not my intention to assert that all queer clinicians should come out. Even the notion of coming out is a western, white concept—to have the power to decide what of yourself to share implies ownership and autonomy over that self (binaohan)—and it does not feel like the best choice for everyone. 

The last year plus will be an indelible reminder that our frame is ultimately a fantasy. And while in many ways it is one of the most essential elements of our work, we cannot hide behind it. Nor do I believe I want to. When it collapsed, I experienced both fear and a wish granted. I experienced a closeness with my patients that felt radically different—uncomfortable in a way that reminds me how brave it is to face one’s reality and wonderful in a way that reminds me how worth it it is to be seen. ■