Inside / Outside

Plein Air Project


New houses for our Psychoanalytic Method

Heather Ferguson

New York, NY

Steven Stern

Yarmouth, ME

Stacy Berlin

Studio City & Los Angeles, CA

Julie Oscherwitz Grant

Deerfield, IL

Jane Jordan

Santa Cruz & San Francisco, CA

Michelle Lalouche-Kadden

Solana Beach, CA

Leslie Lampe Long

Providence, RI

Laurel Spindel

Chicago, IL

Jennifer Struck

Denver, CO

Shaké Topalian

New York, NY

The “exhibit” that follows is the creation of an IAPSP Zoom Group led by Heather Ferguson and Steve Stern. The group, which started as 12, gradually settled at the 8 members who participated in this project: Stacy Berlin, Julie Oscherwitz Grant, Jane Jordan, Michelle Lalouche-Kadden, Leslie Lampe Long, Laurel Spindel, Jenifer Struck, and Shaké Topalian.

As with any non-linear complex process, it would be hard to say just how this project started. It grew out of our group process, which included thinking together about COVID-related clinical issues and conundrums that members would bring to the group, but also out of the uniquely welcoming, supportive, and remarkably open and connected atmosphere that was forming in the group despite the limitations imposed by Zoom. One of the clinical issues that various members were struggling with was how to respond to the small group of patients who seemed literally to need in-person contact for the therapy to feel fully viable. Some of these patients suspended treatment quickly after the change to remote therapy, while others were hanging in but clearly experiencing a form of failure to thrive—a loss of felt connection to the analyst that was simultaneously a loss of connection to themselves. It seemed like the “needed relationship” for these patients required some amount of in-person contact. But how to provide this safely for both parties?

Steve may have been the first to bring to the group the idea of meeting with one of his patients on the back deck of his house in the woods. What might be wrong with doing this? We thought through the issues together: safety, privacy, the imposition on others living in the house, the frame issues involved—mainly the patient coming into the therapist’s home environment and all that that might stir up. Once the group helped Steve think through each of these issues, the conclusion was that there was no strong reason not to offer the invitation to his patient. This group problem-solving process led to others in the group starting to wonder if they too might be able to fashion some kind of office set-up in their back yards or on their decks, and part of what you see in this exhibit is the ultimate outcome of these discussions and experiments.

As these discussions evolved, it became clear that some in the group did not have the option of doing this with their patients because either their homes did not have outdoor spaces at all, or the spaces they did have did not have the requisite privacy or safety. At first, there was some inadvertent insensitivity to these differences in the group. But because of the deeper trust and openness that was developing, some who did not have such spaces took the risk of voicing their envy of those who did. They shared that they were feeling on “the outside” of the group (of “insiders”) whose homes had useable outside spaces. This prompted an immediate course-correction—an expansion of the conversation to include everyone’s love of nature and the outdoors, the sense of confinement that some of us were feeling more than others, the possibility of meeting patients outside in more public spaces, and creative ways of “bringing the outdoors in”—exemplified especially in Shaké’s creative incorporation of her fire escape as an expansion of her experience of her home office space.

Really what was happening here was a transformation in the group wherein the forms of empathy, support, connection, co-creativity that were evolving were not only helping us with clinical problem-solving but making all of us feel less alone in our work and in the isolation imposed by life in the pandemic. In sharing with each other our experiences of doing our work in the midst of a pandemic and recognizing common experiences and questions, we found that we were creating a map or some sense of scaffolding around an unprecedented and amorphous experience. With the changes in our lives that allowed for extra time, some of us felt invigorated by numerous endeavors, while others felt deep exhaustion that comes from creating experience from scratch, without a net and without a framework. The strain felt by the latter group seemed to lessen as we put our ideas together. What emerged in our sharing was a sense among us, implicit at first, that our ‘petals of grief’ were being received. With our shared experience received and held, an unbidden discovery emerged- our individual and shared petals of grief opening for each of us a sense of a new beginning.

People began to share photos (and one painting by a patient) of outdoor spaces where they were meeting patients, and other outdoor spaces that had become meaningful as a result of our group process. At some point Steve suggested organizing these photos and images into an “exhibit” we might share with the membership. Stacy quickly picked up on this idea and offered to do the work involved in organizing the presentation. And it all came together remarkably quickly, with people sharing both their photos, brief narratives and poems, and Stacy artfully arranging them all into a beautifully laid-out sequence.

In Sharing this collection, we are aware of the possibility that others viewing it may have a range of reactions such as the possibility of feelings regarding displays of privilege. In the process of developing this piece many feelings emerged among our members. We hope that what comes through is the spirit of our group, which is one of acceptance, inclusivity and the possibility of transcending—at least at moments—the limitations, isolation, loss, and melancholia imposed by the pandemic and Zoom-life.

We were moved to share this exhibit with a larger audience in the hopes that it can provide a framework, or even something to push up against, during a time when footholds can feel hard to come by. We hope you feel some pleasure and inspiration from our motley collection of photos and narratives. We welcome your comments and invite anyone to share their own experiences seeking ways to connect with patients who need some form of in-person contact and/or their experiments meeting patients outdoors (photos welcome but optional).

Heather Ferguson

New York, NY

On the eve of giving birth to her baby as a single parent, I met with my patient “Heidi.” Eager to meet in-person since I had not been able to see her growing belly over the past five-month, we hoped to fortify our bond over our 11-year treatment. So, after some consideration, we met in the backyard space at my NYC therapy office. An outdoor office space in NYC is rare. I was fortunate to have access to this relatively private, quiet shady space.

I set the stage with the usual therapy accouterments: clock, tissues, water, pen, and paper. I was surprised to notice a wash of sadness, in myself, as I met with “Heidi”, in person, for the new first time. I did not realize how profoundly I had missed seeing her, and other patients, in person.
It alerted me to all the ways I am
sustained, nourished, energized, informed, and engaged by the mutual bodily presence, in its full complexity, with my patients.
Our meeting felt incredibly special to us both after our long analytic relationship. To my surprise, Heidi found the following zoom session painful after the intimacy of our in-person meeting which we were then able to thoughtfully discuss.
It awakened, anew, the loss of our in-person, fully embodied shared space.

Steven Stern

Yarmouth, ME

I had a patient who was not doing as well with the phone (his choice) to the degree that I became seriously concerned. Pre-COVID I saw him 5 times a week on my couch. We were still talking 5 times a week, but his “infant self" seemed literally to need the in-person contact in order to feel enough of a connection with me and with himself to hold him and keep him from descending into a malignant depression/regression.

I struggled for many weeks thinking how to respond to his needs until it finally occurred to me that it would probably be safe to see him once a week on the back deck of our house. When I offered this possibility, he was extremely moved and palpably relieved. His core issue is feeling that he did not really “matter” to either of his parents (in different ways), so the fact that I would extend myself this way for him and invite him to my home, had a profound effect even before we actually met there!

Now we have been meeting every Friday, weather permitting, in the chairs that you see in the photo above. We are 8-9 feet apart and don’t wear masks.

My note from our first “deck session” begins like this:

Everything worked well, and it was a perfect beautiful day. As he sat in his chair he turned slightly away, looking up at the trees (see picture below for his view), and there was a sense of letting go into a calm, connected place. It was clear being in person made a huge visceral difference in his sense of connection (and mine too). We didn’t have to work so hard to “feel together” as we do on the phone…

Patient view

Stacy Berlin

Studio City & Los Angeles, CA

Franky’s mother emailed me last March to let me know he was not up for electronic sessions. Franky is 14 years old. His mother recently asked if I would see him in my backyard. Why not? I had not seen anyone in person yet.
It was exciting preparing a private outdoor corner office where Franky and I would meet after a several months COVID-induced hiatus. I worried about the yard—heat, noise, planes, neighbors, and mosquitoes! How would it feel not being contained by walls?
We sat 10 feet apart, on the edge of our seats trying to hear each other’s muffled voices through face shields. The flight path seemed nonstop, water gushing loudly from the fountain, and neighbors squealing with delight in swimming pools. I self-consciously kept asking Franky to repeat himself. Was he afraid to ask me? Words were indistinct, smiles distinct.
During remote learning sessions with classmates, Franky could not bear to talk. Was I another whom he could not bear? The reason for the break? At school were too many eyes for him to endure—what if he exposed “less appealing selves”?
Phillips states, “We work hard to keep certain versions of ourselves in other people’s minds; and, of course, the less appealing ones out of their minds. And yet everyone we meet invents us, whether we like it or not. … But we are daunted by other people making us up, by the number of people we seem to be. We become frantic trying to keep the number down, trying to keep the true story of who we really are in circulation. This, perhaps more than anything else, drives us into the arms of one special partner. Monogamy is a way of getting the versions of ourselves down to a minimum. And, of course, a way of convincing ourselves that some versions are truer than others—that some are special (Phillips, 1996).”
How do numerous simulated eyes impact Franky? He dreads exposure, while deeply longing to feel whole and a sense of connection and belonging. He doubts his perceptions and judgments, and is terrified of “messing up,” while panicking about being misunderstood. Franky is a bright and creatively rich thinker, full of ideas, and questions his own mind.
Our third outdoor session, seemingly less air traffic, occasional mild screeching, and the fountain was off—we were mutually less self-conscious. My ears adjusted and opened to his voice, and our sharing deepened significantly, prior to the virus. Why did it? Did my intrusive self-reflective voice fade out? Did our long break evoke his fear of breakdown (Winnicott, 1974)? Did he miss the person with whom he felt freer to share? Did he decide to risk showing me more parts of himself? Does my outdoor provision convey the importance of our relationship, its meaning to us both, that he won me over?

My decision to meet with Franky outdoors was our relational event with much to discover. I hope this paves the way towards a more integrated sense of himself during our wildly uncertain world. Does he know that I only see him in-person for now? Grist for the yard.
References:
Phillips, A. 1996 “Chapter (7)” Monogamy Faber and Faber Limited, London, Great Britain
Winnicott, D.W. (1974). Fear of Breakdown. Int. Rev. Psycho-Anal., 1:103-107

Julie Oscherwitz Grant

Deerfield, IL

Speaking of her attachment to her childhood home, Michelle Obama writes in her memoir, Becoming, “You don’t really know how attached you are until you move away, until you experience what it means to be dislodged, a cork floating in the ocean of another place.” For one of my clients in particular, a 60-year-old woman who I’ve been seeing twice a week since September 2019, the sense of feeling ‘at home’ eluded her as a child, the dislodged feeling her norm. Some healing came as an adult with the creation of a deeply loving, attached family. But HER sense of home, which at its most positive would start with her parents and an experience of relational knowing, was tension-filled and shaky. It lacked solidity, reliability, holding. We were deep in the process of creating that together when COVID hit. This self-proclaimed hippie and seeming free spirit had ‘moved in’ to my office almost from the first visit, taking off her shoes, tucking her knees up on the couch, truly making herself at home. Over time she felt I ‘saw’ and understood her, and each session involved her settling in as if it were her space. With a sigh of relief and her emotions close to the surface she launched back in without pause.

When COVID-related distancing began, my suggestion that we meet virtually felt not just disruptive but untenable for her. She unhesitatingly declined my offer to meet online with a striking clarity that I later ‘got’. A technology-mediated exchange presented two obstacles: the presence of a third participant (the computer) would diffuse the intensity of our exchange; and its likely malfunctioning at times would, she knew, shake and anger her like one of her unpredictable, aggressive family members. She could tolerate that anger if it was sparked face-to-face, but I think instinctively knew it would leave her shaken if I was just a face on the screen. So her solution was to update me, without fail, on each of our meeting days, with a text outlining key feelings and events.

She and a few other ‘decliners’ provided part of the impetus for my consideration and eventual decision to meet on my back deck. I also felt a sense of something lost, less pure, that ‘felt sense’ of other more elusive. This, my first experience of working from home, was a learning process, full of SNL skit-worthy mishaps and a sudden motivation to spruce up neglected spaces. But the end result has been positive, allowing for treatment to continue with certain people who would otherwise not be seen. It brings to mind early work experiences doing home visits, which required me to hold and define the therapeutic frame in the midst of stimuli that could easily distract from our joint endeavor. With intention and purpose front of mind, we could resume our work together, as i did virtually with others.

Two and a half months in, the handful of people I see at home and I have established routines of engagement, from how they signal arrival to adaptations due to weather (front porch with a wraparound screen). They are settling into our space, and even my dog’s frequent request to join us mid-session has become part of our process, hardly disruptive. I can keep my therapist’s hat firmly on my head, a gloriously familiar, welcome feeling in this out-of-control time. Online, too, each client or couple and I have adapted, reinforcing our connection (with the added, sometimes unspoken sense of being ‘in it together’ as it relates to COVID) and engaging as before in the work.

Postscript: We have now passed the six-month mark. The midwestern spring and summer months afforded me and my in-person patients the luxury of meeting outside comfortably. Anxious feelings are ramping up for many of them and for me privately as we anticipate the winter and the greater isolation and disruption it will bring. Already I am incorporating blankets into my outdoor offerings, and they are being used. As I plan for the snowy months, I realize it is not a matter of IF but WHEN we will face further adjustments to space. Former ‘constants’ like our meeting space no longer exist; this is our new normal. So I use recent history to reassure myself that I and my patients will weather what comes because we’ve gotten this far. And that realization deepens my belief in the therapeutic endeavor, its resilience and sustainability. With all the uncertainty and instability in our world at present, the resilience of my patients, and the continued vitality and richness of this work, as challenging and painful as it can be at times, is helping me balance my worry and fear with hope.


Shaké Topalian

New York, NY


I have no outdoor space except for a fire escape which has been therapeutic for me and ultimately for my patients as I have witnessed the birth of two mourning doves who cracked open their eggs, and poked their tiny heads from under their mother’s warm protective body. I looked on in awe as she fed them and watched closely over them as they began to explore the length of the fire escape, practice fluttering their wings, and finally spread their wings and fly away. They gifted me with pleasure, hope, and inspiration that opened up a creative space in me, a freer space that facilitated a deeper resonance with my patients as we grieved the loss of our lives as we knew them, my office and what it meant to us, the ability to be truly together. The witnessing has taken place through my windowsill garden of zinnias, geraniums, mint and basil. I believe all this growth and life on my windowsill and fire escape has helped me to stretch my empathy, play in my mind, and maintain my analytic sensibility at least most of the time. Thank you, Heather, for sharing the symbolism of Mourning Doves  :) 
In some cultures, the mourning dove stands for new beginnings, great expectations, and deepening spirituality. These birds may help us to find inner peace and go about our lives calmly and with purpose.

Jane Jordan

Santa Cruz & San Francisco, CA

Once upon a pandemic

Thirty years ago, a freckle-faced young college student with a huge mop of curly blonde hair arrived at my office in San Francisco after negotiating the city hills via skateboard. He became my third control case. After successfully completing his analysis five years later, he went off into the world, where he built a wonderful life for himself that I learned about through occasional holiday cards. Last week I heard from him again. He and his wife and four children were taking a road trip from several states away that would bring him to California.

He remembered that my home office in Santa Cruz, 75 miles away, had a back yard, and he proposed that we meet there. For COVID-related reasons too complicated to explain, I was unable to see him. Perhaps in another 25 years, he’ll come back to California again . . . The loss I feel about this missed opportunity evokes for me all the other losses brought about by this pandemic.

These photos of my empty back yard give new meaning to the concept of potential space.

“For of all sad words of tongue or pen,
The saddest are these: ‘It might have been.”
--John Greenleaf Whittier


  • This photo of my empty back yard gives new meaning to the concept of potential space.

Leslie Lampe Long

Providence, RI

The Artist, depressed and blocked in her attempts to create
Entering my office 8 years ago bereft, lost
Both her marriage and her art, fraying.
We begin to find our way…her art- the antennae to explore
I present us with a larger table, inviting visible creativity
Over the years- design, imagination, poetry, and magic fill our space
Attending her first gallery shows, I see her vital self, reflected in every displayed creation
Her relationships begin to repair…
Soon, her independent business: her work shaping her own clients’ imagination
Opting to suspend our sessions with Covid…
We’ll resume when this is over, she promises.
And then, the ask for an in-person session in August.
She has creations she wants to share.
Outdoors, I respond, September?
Not wanting to wait, resuming online with the promise of the outdoor session to follow.
“Learning in the form of unbidden perception, is what happens when a space appears between experience and expectation... new experience emerges inevitably in the form of alternatives to the familiar.” (Donnel Stern, 1990) The shift from traditional in-office settings to a plein air office (or fire escape) without walls invites surprise as we venture out of the familiar, “lifting something out of the alien, thus broadening and enriching our own experience of the world.” (Gadamer, 1966)

I'll use this picture and ask if she

would like the larger table. 

Painting

[Outdoor Therapy Space]

Anonymous Patient

This is a painting I saved from a patient when my practice was in NYC (15 years ago). She depicted our chairs after a session, if we had actually met outdoors (patient permission to use painting).

Not to spoil the image of an idealizable transference, this painting of an outdoor therapy space was created by the same patient who painted me as a blonde Madame DeFarge!
Leslie works with countless artists.



Zig Zag


      In early March, before we knew what lay ahead, I had to move quickly to online therapy upon my son’s return from abroad; with a cough! Testing, tracing, social distancing were still foreign concepts. Masks were still for Halloween.

Zig - All my patients were on board and we adjusted and improvised as needed. Phone, Doxy, FaceTime, and finally HIPPA Zoom. (A new sort of animal)

Zag- Some refused video and searched for parking to find space to talk with me by phone. As the weather turned warmer, they drove around and around seeking shade, then asked, please, can we come and sit with you again. We long for your tissues, not wanting to provide our own, some lamented!

Zig- My backyard perhaps? A beautiful sunny place. But too sunny and not private enough, I very quickly discovered. Neighbors too close, with hammers, loud voices, and their children laughing and crying.

Zag - Back into my office, this time not only with tissues and a couch, but a HEPA filter (the right one, who knows?). Masks and white sheets to protect each patient and myself.

Zig - With fogging glasses, sitting six to eight feet apart, white sheets, the hum of the filter running, the sessions felt odd. Joy to be together and yet, not in the familiar comfortable holding space we were accustomed to.

Zag - New patients. Never seen embodied. Needing to be heard, nonetheless. Long time patients, cocooning for some, others longing to feel our familiar space together.

Zig/Zag has been my internal and external experience of this past several months of 2020. Grateful to be working, connecting and attempting to hold space. Zoom fatigue and Zooming, now verbs forever in our lexicon.

Below is a picture of my office with couch sheet covering, hand sanitizer, HEPA and masks provided. A strange new world.

Michelle Lalouche-Kadden, Ph.D.
Psychologist and Psychoanalyst

Laurel Spindel

Chicago, IL

I don't have an outdoor space to see patients, though I wish I did. I think it could be very beneficial for, at least, a handful of them (and me), especially those who have been in crisis the last few months. With these patients, in particular, it has been a challenge to be in the one-dimensional world of the video screen and be deprived of the full catalogue of senses to assess risk as well a “flight into health.” Creating a feeling of safety within the world of pixels for patients who are working through early-life trauma is a unique challenge, especially with those who can dissociate during session or who struggle with fears of abandonment.

In July I took some time off and away from the city and it turned out that one of my patients was going to be vacationing nearby. We agreed to meet since it felt to both of us that this might be one of the few opportunities we would have for many months to see each other in person. We could meet outside and be among the trees and near the water and have a kind of privacy that we would never be afforded in the city. It felt important to take advantage of this gift to be together, especially because this patient’s mother abandoned the family when she was a child and connection in relationships, including ours, can sometimes feel tenuous to her. The work has remained rich while working on video but the scars of her abandonment have become more present in enactments in the treatment. I hoped that meeting in person would provide a felt sense of the connection that can feel so out of reach during a video session with an unstable internet connection.

She suggested we meet at park near her condo and she sent me a picture (below) so that I could locate it easily. We decided on BYOC (Bring Your Own Chair) and it was lovely to put eyes on each other again. Actually, what I found interesting was how intense the eye contact felt; both of us commented on it. She has blue eyes and it felt like looking into a lamp with a 100-watt bulb rather than a 40-watt bulb. I think we had both adjusted to the facsimile of eye contact on video and while it was a delight to have real eye contact, it took a bit for each of us to adjust; it was almost too bright at first. I wonder if there’s a way we have been straining our senses so much on video that when we met in person they were working too hard and everything seemed “too loud.” Or, had we dulled ourselves in our adaptation to virtual therapy such that the “full orchestra” of real life was like coming out of a cave after hibernation and having to “turn everything back on again?” Once we adapted to the new “old normal,” we got into a familiar rhythm and we hummed along. A robin joined our session for a period and we invited him in; the waves lapped in the distance.

Pursuing Presence by Julie Oscherwitz Grant

Amidst the pandemic, as normal life ceased
Ten psychoanalysts cooked up a feast
Having honed thoughts we explored over time
Inspiring each other, in moments sublime.
Here’s how it happened, quick like a sprite
That this disparate group found connected delight.
We began with a question, what is it like
As for our patients, we TOO feel each spike
In COVID, alarmed and confined, how do we
Remain true and present for those who we see?
Zooming with honest expression and heart
Our striking connection evolved from the start
Enlivening all to express what we feel
And how each approaches this mission to heal.
Then as the months passed, recognition was found
That some were expanding our working surround,
To include going outside with patients, but how?
Let’s answer we said with intent, starting NOW!
So we wrote, photographed, emailed ideas cross miles
And reacted with wonder, some edits, all smiles
Then voila! What emerged and began to take shape
From our magical process, at times mouths agape
Was a blend of ingredients, one-of-a-kind
A layered concoction, ten voices combined.
How sweet was this process amidst time so bleak
Isolation it shadows us all week to week
But connection, our antidote to time adrift
Yielded a process that gave us a lift
And formed Plein Air, a loving salute
To our work and the way joint pursuits can bear fruit.

Inside / Outside

Plein Air Project


I am inspired by this group of supportive, intelligent, creative clinicians as well as by our patients, mutually calling on the courage to adapt together to new circumstances/settings and new ways of being. We are truly “emotionally dwelling” (Atwood & Stolorow, 2016) with our patients during this unprecedented time.
Jennifer Paul


The End