Trauma & Dissociation in the News

Between the screen and the mask: on life and teletherapy in the time of the pandemic

This article first appeared in Attachment New Direction in Psychotherapy and Relational Psychoanalysis, December, 2020 (issue 14/2). Reprinted with the kind permission of Phoenix Publishing House.

Abstract: The unexpected appearance of the deadly coronavirus that landed on our doorstep has hit us from left field. For a while the boundaries between my personal life and my work as a therapist felt meshed and burdened with fear, a collective sense of disorganisation and loss. In this article I try to capture and organise some of the experiences and events which took place during the first six months of the pandemic.

Keywords: pandemic, lockdown, fear, loss, trauma, time.

It’s getting hard to breathe round here, to think round here. And we’ve been sold a thousand lies this year.

(Lanterns on the Lake, 2013)

In her BBC Reith lectures on war, the historian Margaret MacMillan (2018) described the slowdown of night and space during war, how the colour of seasons changes, how small objects become so important, and above all, how uncertainty breeds fear.

Lockdown weeks 1–2: fear

Here in London, it was in early March when a deadly virus entered our ports and hit us from left field. Life as we knew it came to a rapid standstill. Conversely, the explosion of Spring had never been more noticeable; the unusually bright daylight made sharper by the disappearance of pollution, the birds singing uninterruptedly, and the trees and flowers early to blossom, all added confusion to the immediacy of fear that had landed on our doorsteps. And while we waited for the politicians who minimised the extent of the threat, the banality of their denial meant that safety measures were slow to penetrate. Survival is a strange habit; when fear sits at the forefront of our amygdala there will be a greater effect as it permeates our bodies, so when the lockdown finally came in, the ghostliness of our streets never felt more beautiful; what used to be bright felt brighter and what was dark felt darker.

Similar to war, being subjected to such rapt attention and comprehension, this virus quickly violated the norms of society around the world when time and space lost purpose in their temporality. Yet unlike any previous war or plague, our virtual connection meant that this pandemic created an unprecedented collective helpless- ness and a global sense of vulnerability.

On the main road, a few blocks away from where I live, the sound of ambulances was defeating in its frequency, a numbing experience and a reminder of an invisible enemy that knows no borders and has no boundaries. As someone who grew up in a country riddled by wars, this pandemic is an event of collective importance but also a personal affront. The sound of sirens, panic food buying, and seeking shelter away from danger, albeit in a different guise, are familiar and my fears are all too biased. Easily led by terror, my well-practised hypervigilance went right back to where it once started. I was, therefore, one of the first therapists to migrate to work only online. Shielded behind the screen, my smile zoomed into the new light and darkness of my clients’ homes. To begin with, it seemed easy to just get into our survival dungarees, forget our beautiful shoes, and march on with the next task whilst finding positive meaning in this new paradoxical reality of feeling connected yet being so far apart.

During the first week of the lockdown one of my very traumatised clients became sick with the virus. Whilst lying in bed, she texted, telling me that she could really do with a session. My instant response was to say “No! Stay in bed please!” But she pleaded saying that the isolation was worse than the disease, and so it didn’t take long before I agreed. Seated close by, our heads almost touching the screen, I felt protected by the illusion of closeness. Still I won’t lie, my mirror neurons were firing; I flinched at every sneeze, my body shuddered every time she coughed. Nevertheless, like Clarice Starling felt when she first visited Hannibal Lecter in prison in the film The Silence of the Lambs (1991), I too felt fear but also invincibility facing the unpredictable raging virus. Sitting in her pyjamas, her usual youthful look was pale, the heat from her body was invisible yet noticeable, her chest felt tight, and occasionally she would run out of breath, and so for a while we sat in silence, not doing very much. In my twenty years of working with traumatised clients, this union was by far the most unconventional I’d had. Our skinless knowing left me feeling like a therapist, a priest, a friend, and a mother who couldn’t hold her sick child in her arms. We then decided that half an hour was enough. I told her that she could fight it, that she is a true hero, and how proud I was of her. She said that she felt held. I wished her better, our closeness widened: she was grateful and so was I.

It was during the second week of the lockdown when I fell ill. Unable to work, I notified my clients. Being unwell meant that my fears from both past and present met with an added level of unknowingness. My helplessness was similar to that of a child in need, a care-seeker who could not think about anyone else but herself. I was lucky enough to be cared for by my family, but also by a kind neighbour, Dr Kim Lau, who like a guardian angel kept an eye on me. In my absence, some clients behaved impeccably well and showed good manners and consideration, some disappeared in silence as if not to disturb me, and others expressed the pain of separation with some distress and fury. One way or the other, it was interesting to observe their responses to my unavailability and how it matched their attachment style with regard to dependency: the clients with avoidant patterns of relating tended to under react; the clients with preoccupied patterns would overreact; and the clients with the disorganised patterns would react disproportionally and even inappropriately, such as a very traumatised client with a history of severe abuse who would regularly send me messages: “Why are you ignoring us, what have we done to you? Are you giving us the cold shoulder? We should have never trusted you!” Like an abandoned infant (she once was) unable to self soothe, her attachment cries were the loudest.

After two-and-a-half weeks, I was able to resume work. It was then when I felt a greater appreciation of Ainsworth’s strange situation experiment, which helped me see the parallels of the different attachment styles the one-year-old showed, to the one that my forty-year-old client showed upon reunion. When we finally got together, seated in front of the screen, I was greeted with a prolonged silence (for a moment I worried if there had been a technical glitch of a frozen screen) which was followed by a torrent of protest about my abandoning her. Still feeling weakened by my illness, I failed miserably to attune and regulate this angry “toddler”. Instead, I shrugged my shoulders and replied with some disdain: “Can we say hello first?” Unable to contain her distress for much longer, she simply pressed the escape button and disappeared in a flash. The speed with which I was blanked out left me no time to manoeuvre. This was a new fight/flight experience and I was not skilled to predict the order in which the eruption took place. There was literally no space to negotiate. In the past when working face to face, if and when things got too intense with a traumatised client, I tended to work with the body and the five senses, which helped them regulate. For example, I would offer the client a Rubik’s Cube, a soft fabric, a favourite scent, a drink, or play some music. Feeling somehow cancelled by the mastery of her control, I was thinking what else can touch our screen that smells of lavender and tastes of ice cream. I then texted her an apology written in a language that would normally appeal to her child part and in a flash she returned.

Lockdown weeks 3–4: numbness

Trauma is when the familiar trips you up, sending you to an immediate state of fear, helplessness and unknowingness. Often when writing about trauma, social scientists and psychologists will write after the catastrophic event has taken place. The speedy dizziness with which this virus invaded and threatened to take our lives within days, has given us no time to temper fear with reason and for a perspective to have its say. Thus, finding distance from the entire crisis during the social distancing was hard. Being under siege meant that the context of our usual being collapsed with no time to prepare, and all the chimes and charms that London had to offer were no longer available.

During this altered time, not being able to make sense of the world is stressful and we find ourselves stuck in a liminal space between not knowing and what is yet to be known. The only uninvited guests to knock on our door are the “Amazons” and since physical contact has been snatched from us I began to notice the stiffness of rejection while my body ached with alienation, longing to hug my dear ones. Each day on Newsnight we meet the dead for the first time, we learn about the bereaved who could not hold their relatives’ hands for the last time, nor could they attend their funerals. We also hear of the shortage of PPE and the large fatality rate among our NHS caregivers and among bus drivers of our city. We  witness the shock  and numbness marked on the relatives’ faces who have to attend their relatives’ funerals on FaceTime only. Winter has yet to sink into their hearts. Searching for the cure our grief began right then, and whilst waiting, every Thursday we stepped outside our front doors and cheered our frontline heroes in the NHS.

Lockdown weeks 5–7: confusion

How did it get so late so soon? It’s night before it’s afternoon. December is here before its June. My goodness how the time has flown. How did it get so late so soon? (Dr Seuss, n.d.)

As this pandemic wields control over our lives, when the good weather offers us a false sense of normalcy, and when there is not much “doing” to be distracted from, time passes with incurable stillness and the days seem to merge into one. Strangely enough, during this Sisyphean time, I developed a sense of rapport with endless- ness; the sameness of the days meant that on a few occasions I found myself getting the wrong time of a session with some of my clients. In the seventh week, on a Monday morning, I was woken by my husband asking me: “Don’t you have a client at 9 a.m.?” I replied: “But it’s Sunday!”

The duality of time passing both slowly and quickly, being both empty and busy, is disorienting to the well-trained mind and tracing the process of my thoughts I still struggle to cohere. Someone on the radio said that every day is “Blendsday”. We seem to have more time on our hands, yet many people complain about how unproductive they are, how they can’t read the books they always wanted to read or clear out their cupboards. On different forums therapists report how addictive and tiring our online life is. I have coined this kind of dependency as “Attachnet” (Badouk Epstein, 2014). This fatigue, social experts explain, is felt by many individuals across the board and can be explained as how, once upon a time, not long ago, our social energy and attention was divided between commuting, offices, cafes, restaurants, cinemas, gyms, etc. Still adjusting to this new norm; our bodies are now stationed in front of one screen, deprived of healthy blinking, our eyes are fixed on the person facing us on the screen, and our efforts are now channelled through one location. No wonder then that while our mirror neurons experience this new form of exhaustion, our imprisoned bodies express confusion.

Having replaced the traditional framework of a session of sitting face-to-face or lying on the couch, the work online has given some clients a confidence in the virtual space to express themselves without make-up or high heels. Arriving at the session means being there immediately, with no need to change their clothes and commute. Instead they could lie down in their beds or sit by their windows, like a house cat who has learned to maintain a safe distance even when feeling a sense of belonging. To my surprise, the collapse of the therapeutic frame has not been a great hindrance to my work with my very traumatised clients. Since for the very traumatised, those who spent their childhood in splendid isolation and dissociated terror, these shrunken times make little if any difference. “What lockdown? We’ve always lived in a lockdown, now you know how we’ve always felt!” one client exclaimed. Another said: “Covid has been nice to us.” For this client group staying indoors can feel less threatening, since people who are too unwell to socialise need to see their suffering reflected in others. For them, the pain of exclusion has become a collective experience, we must not confuse this with Schadenfreude. What’s more, the compounded virtual space can somehow offer a kind of freedom, such as the client who found safety talking to me from the depth of her wardrobe. These clients who have had long battles with depression and spent many days in bed or inside their own heads it seems, have been prepared relatively well for this pandemic. Furthermore, for some of my clients, being a full-time parent has proved to be heaven in disguise for their young children who had issues around separation anxiety. The journalist Hadley Freeman wrote in the weekend column of the Guardian (2020): “But it is lovely to eat three meals a day with my kids and to see how much they love it, too. Self-isolation with their parents is, I have realised, a small child’s fantasy come to life.”

Lockdown weeks 8–10: despair

Whilst thousands of patients are still lying unconscious in ICU units across the country and care homes are still suffering from government neglect, our itinerated life is now fully disrupted and there is a general sense that we don’t know the rules and the rules don’t know us. The thinning newspaper can now slide easily through the letter box, a sign of the economic crisis that is now upon us. Anger and frustration have begun to replace public numbness.

During this subjective time, my kindly father-in-law passed away. I wallow in the sombreness of grief. The restricted gathering at the funeral allowed us to mourn intimately and without much pretence.

Three days later a dear colleague and friend also passed away.

Philip Bromberg left us on the morning of 18 May in New York. His sharp mind and clinical observations were written in such a poetic dream-like manner, yet his radical thinking about trauma and dissociation will be remembered for his free of conventions, emancipated mind and interpersonal and passionate style. In one of the emails he wrote to me, he reflected how he thought that I helped Bowlby be recognised, not just as a theoretician, but as a person and he did the same with Sullivan. We cherished the fact that we live in our mentors’ borrowed light and together we pondered how the two men would see dissociation today. Memories, even if not rooted in a traumatic event, are painful because going back means acknowledging the loss that cannot be reclaimed. Philip, you will be missed but your writing will keep company with me. Being inspired by Philip’s article: “The mirror and the mask” (Bromberg, 1983), I have written this poem:

Baby Narcissus
with the slow down
of night and space,
baby Narcissus was born again.
His birthplace
impeccable looking
perfect in every sense,
abundant with vitality
his cries intense:
me, me, me
and only me!!!
Alas, his mother’s face
masked in blue
frightened by yesterday
and now by tomorrow, too.
Her eyes glazed over,
lockdown with numbness,
Oh, little wee boy,
my joy, my terror!
with no mirror
to refuse
all by himself
he lies against the wall
isolated and without a self.
Her tender arms
weak and tall
afraid to touch
an invisible virus, poor
baby Narcissus
couldn’t ask for much.

It’s the end of May, no longer gripped by the news, my shock stagnates, there are more than 400 fatalities a day!

Lockdown weeks 11–12: protest

This summer, as we navigate our way through this testing time, a deluge of PTSD will come our way, when we will have to grapple with the loss of life, loss of routine, loss of the physical, and loss of the familiar. In his podcast “In the shed”, the poet Simon Armitage (2000) said: “The population of the world is me.” Finding the balance between socialising and solitude has always been a source of tension for me. I tend to perceive this balance as freedom. Alas, it is the loss of this balance which has been taken away from me, you, and us.

In my attempt to seek meaning during this crisis, I returned to Bowlby’s seminal book on loss (1980). I read and find comfort in his wisdom: “Since loss as a field for enquiry is a distressing one, the student is faced with emotional problems as well as intellectual one” (p. 7). Whether secure or insecure, I notice that my fear system has been activated in equal measure to that of some of my clients. This virus clearly does not detract from the original loss and has only highlighted some of the old maps already imprinted on us. Having said that, I also notice how much of our vulnerability has been threatened unequally: while the privileged can afford to obey social distancing rules, the poor will have to rush back to their workplaces to pack and deliver our foods and medicines, and put their own lives at a greater risk. As the search for a cure or vaccine continues our grief prevails, the number of deaths in the UK is still the highest in Europe. Aggression, according to Bowlby, is the punishment of the “anger of hope”. This is where the child’s protests against their parents are not usually being heard and addressed. It is when separation and abandonment have been dismissed and frowned upon that the child’s anger will be transformed into what Bowlby considered as the “anger of despair” (1973). Since we stopped clapping for the NHS staff, the nurses’ pay rise has been rejected. In the US the murder of George Floyd by a white policeman and his last words: “I can’t breathe,” echoed through social media and has created an unprecedented global uproar and protest in the Black Lives Matter movement. A Black client tells me about her nephew who has developed a real fear of policemen and how his fear of the virus has compounded his fear of leaving his  home.

We share this moment of radical change; time will tell whether this social outcry is a protest of hope or despair continuously refreshed.

Week 13: depression but also hope

Attachment theory, according to the sociologist Peter Marris:

… provides an interconnected set of links between the social and psychological aspects of human behaviour which seems to me very powerful, as an organisation of meaning in its own right. (Parkes et al., 1991, p.  89)

Thus, when a global crisis such as Covid-19 hits individuals, organisations, and nations, our purpose in life is disrupted, and with this shift comes the risk of regressing to a more concrete purpose and we try to convince ourselves that we can live without what we cannot have anymore. Therefore, in order to truly be able to make sense of our experience, we must accept that we have to go through a mourning process, and that it may take some time for us to consolidate the meaning of the loss we are collectively enduring.

With cautious optimism we emerge from this lockdown. I can now hear the return of noisy traffic, hushing birdsong, and see the polluting smog reappearing in the distance. When I go down to the shops it is only a third of my face that connects with the shopkeeper, our smiling eyes meet and greet each other with a pre-Covid familiarity but with added tenderness. The streets are still empty and  so are many shop windows. Depression may be with us for a while longer. Nevertheless, the not so British weather has given me permission to meet a few clients in a small local park. Seeing my client upon reunion, standing roughly two metres apart, my fear jostles with joy. We smile with a wary breath, we sit on the grass and touch the earth, we share our appreciation of the good weather and  the second chances life has to offer; the line of the song by the Hollies plays in my head: “Sometimes all I need is the air that I breathe and to love you”. My client then shares with me a saying she has learned from her spiritual mentor: “Love is contagious, let’s be a carrier.”


Armitage, S. (2020). In the shed (podcast).

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Freeman, H. (2020, 11 April). Small talk and ready-made sandwiches: things I  don’t  miss about normal life. Guardian Weekend. apr/11/small-talk-and-ready-made-sandwiches-things-i-dont-miss-about-normal-life (last accessed 9 December 2020).

Lanterns on the Lake (2013). Another tale from another English town. From Until the Colours Run (album).

MacMillan, M. (2018). War and humanity. BBC Radio 4 Reith Lectures.

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Orit Badouk Epstein is a UKCP-registered attachment-based psychoanalytic psychotherapist, a trainee supervisor, and a trainee therapist. She trained at The Bowlby Centre, London, where she is the editor of the journal Attachment: New Directions in Psychotherapy and Relational Psychoanalysis. She specialises in attachment theory and trauma and regularly teaches, writes, and present papers and book chapters on these topics and consults worldwide on attachment theory. She runs a private practice and works relationally with individuals, couples, and parents. Orit has a particular interest in working with individuals who have experienced extreme abuse and trauma and have displayed symptoms of dissociation. She is the co-author of the books Ritual Abuse and Mind Control: The Manipulation of Attachment Needs (Karnac), Terror Within & Without (Karnac) and was the co-editor of the ESTD (European Society for Trauma and Dissociation) newsletter for ten years as well as being a regular contributor of articles and film reviews. Email: