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Psychoanalysis Online 3

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Psychoanalysis Online 3: The Teleanalytic Setting is a highly topical, continuing conversation on the role of technology in psychoanalysis and its tremendous potential for outreach to patients in the global economy. It describes the essentials of a framework for teleanalysis that is secure in terms both of technology and ethical stance. The technology is a third in the therapeutic alliance and its impact needs to be analysed like every other element in the field. Teleanalysis appears to some people to be a distancing methodology but the authors report surprising closeness across a distance. Teleanalysis offers a window into the analytic pair's experience of time, space, deprivation, fantasy, and physicality and shows unconscious dynamics displayed graphically on the image on the screen. The book looks at the convenience and impact of internet use among various communities including LGBTQI in terms of defense against and transition to intimacy, and gives clinical evidence of transformation made possible through the therapeutic aspects of technology.

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Chapter One - Teleanalysis Beyond Skype

ePub

Jill Savege Scharff (USA)

I began teleanalysis some years ago because colleagues in another country with no psychoanalysis at all requested analysis conducted on the telephone. I do not like talking socially on the phone, and I was skeptical. But there was no other way for them to get the analysis they sought. So I agreed to try psychoanalysis on the telephone. Then I found that, even though the analysand's body was not in the same physical location as the analyst, and working on the telephone I could not see the patient, unverbalized feelings were transmitted anyway (Scharff, 2012). Two of the patients introduced me to Skype, the most frequently used Voice over Internet Protocol (VoIP), along with the use of a web camera. They preferred the audiovisual dimension offered by Skype because online connection was much less expensive than telephone, and they wanted to see me and be seen as they spoke. So I switched to Skype (at that time believing it to be totally secure).

 

Chapter Two - Analytic Dialogue: Its Multiple Transformations—Clinical Implementation through Telecommunication

ePub

Ricardo Carlino (Argentina and Mexico)

The crucial element of clinical psychoanalysis is the dialogue between analyst and patient. For this dialogue to occur, the basic condition must be met: each inhabits a prescribed role in a specific situation agreed upon in the analytic contract, which contains an appropriate framework for the task. If this condition for psychoanalysis can be met while patient and analyst connect using information and communication technology (ICT), then they can conduct an analytic treatment at a distance. This proposition is framed by an already long period of socio-cultural transformation (Carlino, 2000), which is changing our way of conceiving of, and going about, everyday communication, making ICT of utmost importance in contemporary life.

The real and the virtual in the teleanalytic dialogue

We are now far from the dawn of history, when it was essential to recognize reality through sight and touch, the sound of an object, smell, and taste. In those remote early stages of knowledge, sensory experience built up the sense of reality. Beyond what could be touched, seen, smelled, and tasted, there lay the realm of the evocable, and the imaginable, but what could be imagined was not, back then, possible to actualize. What I would like to convey is that several completely new experiences that had always been impossible to imagine began, at some point, to be possible. Suddenly, what had been purely from the realm of science fiction became something real. Couldn't telephone communication, which we've known throughout our lifetime, also be thought of as either virtual or real? It is easy to imagine that the first telephone experiences of the nineteenth century produced affective–intellectual upheavals.

 

Chapter Three - Privacy, Telecommunications, and the Psychoanalytic Setting

ePub

John Churcher (UK)

What are the implications for privacy when telecommunications are introduced into the psychoanalytic setting? In the classical setting, shared tacit knowledge about buildings enables privacy to be maintained, but this is insufficient when telecommunications are involved. We find it hard to know where to turn for expert advice, but there are conspicuous examples of bad advice, for example, those concerning Skype. From revelations by Edward Snowden in 2013, we now know that interception of telecommunications, including telephone and video conversations, is occurring on a massive scale and indiscriminately. Our reaction may be to turn a blind eye, disavowing the danger to privacy that this interception entails. As Freud showed, this is a defense against a psychical trauma, the fear of something intolerable happening in the future, and involves a splitting of the ego. José Bleger's view of the setting as a depository for the psychotic part of the personality implies that this splitting will undermine our work in a particular way. It will also tend to happen differently in countries and communities with differing social and political norms. It is unclear whether “good enough” security of telecommunications is in principle available, or what it would cost, but even the best systems are compromised by our poor “endpoint security.” Our only option, if we wish to continue using telecommunications as part of the psychoanalytic setting, is to try to analyze these difficulties within the setting itself. This will mean being honest with patients and ourselves about the new situation, undoing the disavowal, and proceeding on the basis of an “acceptance” of the uncertainty.

 

Chapter Four - The Analyst's Closeness in Long-Distance Psychoanalysis

ePub

Claudia Mizrahi (Argentina)

Introduction

Technology has greatly affected the practice of psychoanalysis. A new setting has been introduced to us. While working in technology-assisted distance analysis, I have often seen my prejudices and principles questioned. Why do we talk about long-distance psychoanalysis if the patient feels very close despite communicating through technology? Is it psychoanalysis at all? What are the differences between teleanalysis and co-present psychoanalysis with the body of patient and of analyst in the same room? How do new technologies affect us? We frequently think that technology stimulates the development of a narcissistic psychic apparatus—much like the one Freud described in his early paper (Freud, 1911)—which is apparently eager to get rid of its drives without regard to its need for objects. However, we live in complex times. On the one hand, while we observe increasing disconnection in very small children who are overexposed to technology, we also observe, on the other hand, an important gain in many other areas. I think it is important that we adopt an open attitude toward this, avoiding prejudices in order to try to deepen our understanding of the phenomena that we observe and experience. I do not support the demonization of technology. I agree that it may have risks, but I think the value of technology depends on the use we make of it, and I believe that it may well be an important resource.

 

Chapter Five - Light and Shadow in Online Analysis

ePub

Andrea Marzi and Giuseppe Fiorentini (Italy)

Introduction

New technologies and the current methods of online communication upset the spatial and temporal parameters to which psychoanalysts are accustomed (Shanyang, 2006). They require us to confront and give meaning to the new ways in which our minds increasingly have to interact and our relationships have to take shape. A variety of elements contribute to widening our perspective, including—we would emphasize—the changes induced by contemporary society such as increased mobility, and changed working circumstances. Difficulty in finding patients in large urban areas may also drive us to offer online analysis. It has been pointed out that this practice is very promising in terms of expanding the services provided to a larger number of patients, especially those who may have great difficulty participating in a classic treatment and those who would not be able to do it at all (Martin, 2013).

A raging debate, even fiercer than the one on the interface between psychoanalysis and the Internet and between psychoanalysis and the use of information technology (IT) in the early twenty-first century, has started in analytical circles regarding online analysis—and it is still unresolved. We must critically review the spread of services and publications on the web which seem to “take up the cause” of the Internet at all costs, dangerously overlooking the assumptions, the theoretical and technical features, the ethical caveat, in the name of always being to the fore—and let us admit it—in the name of cheap and simple utilitarianism. These topics have a great theoretical and technical value for psychoanalysis and cannot be ignored. We have to understand this new frontier better and more thoroughly, to grasp the potential of its use.

 

Chapter Six - The Space and Place of Psychoanalytic Treatment: A Philosophical Meditation

ePub

José A. Saporta (USA)

Video conferencing allows us to offer psychoanalysis and psychotherapy to previously inaccessible patients. The enthusiasm of psychiatrists and psychologists in countries such as China to learn psychoanalytic concepts and to experience psychoanalytic treatment is matched by the enthusiasm of many American clinicians, such as members of the China America Psychoanalytic Alliance (CAPA), to make supervision and treatment available to patients in China through video conferencing software programs such as Skype, VSee, and Zoom. The International Psychoanalytical Association has voiced reservations for using analysis over video conferencing for training analysis (IPA document, n.d.), and there is a COPE study group at the American Psychoanalytic Association for considering the effects of this sort of technology on psychoanalytic treatment (Jacobs, 2016). I have been pondering the exciting possibilities—and possible downsides—of expanding the reach of psychoanalysis and psychotherapy through the medium of these video software programs. As I have mentioned this to others, I have noticed that some respond with enthusiasm while others instinctively recoil. These two poles in people's reactions may reflect opposing views on the effect of technology and of physical context and space on subjective experience.

 

Chapter Seven - The Effect of the Analytic Couple's Shared Physical Presence on Transference Fantasy

ePub

Lin Tao (China and UK)

Teleanalytic work has been spreading around the world. The technology-assisted setting challenges the traditional analytic format of meeting in the analyst's room in many ways, encouraging us to explore many aspects of the analytic setting and process that we may take for granted. In this chapter, I will describe the first meeting in shared physical space of an analytic couple after long-term teleanalytic work so as to illustrate the clinical meaning of the patient's transference fantasy in the situation where sexual transference emerges because there is then a sense of possibility of its gratification being realized. I will briefly discuss the combination of psychoanalysis in the analyst's room and teleanalysis in cyberspace.

Clinical background

Mrs. A is in her early thirties, married with a five-year-old daughter. She is a teacher in a city in a European country, to which she emigrated years ago. She has been in analysis with a male analyst for over two years, two sessions a week, conducted through the Internet with a web camera, never having actually met her analyst in the consulting room. They had their first meeting online and continued their analytic work through the Internet from then on. In teleanalytic work, Mrs. A mainly talked about what happened in her life. She expressed her feelings about experiences in her childhood. She trusted her analyst, felt close to him despite their geographical separation, was eager to hear how he understood her, and felt supported and contained. In short, she developed a positive transference towards him. At first, she didn't want the opportunity to meet him in person, but as she settled more and more into analytic work through the Internet, she gradually felt, and expressed her wish, that she wanted to meet the analyst one day in the shared physical analytic room. She had some sexual dreams in which she was physically very close to her analyst. Despite that, she couldn't go deeper into exploration of her sexual transference.

 

Chapter Eight - The Setting, the Screen, and the Conveying of Unconscious Dynamics

ePub

Caroline Sehon and Jill Savege Scharff (USA)

The analyst, Caroline Sehon, presents two teleanalytic sessions six months apart in the context of analysis usually taking place in her office. Jill Scharff provides a commentary, drawing on the analyst's observations and descriptions of her countertransference and on the reactions to this clinical material presented at a teleanalysis clinical research working group in which the co-authors participate to study analytic process material of sessions conducted by telephone and/or encrypted video teleconference (VTC). The material is disguised without disclosure of any identifying information about the patient, and the research group focuses on the relationship between technology and analytic practice. The co-authors discuss the impact of the teleanalysis setting on the analytic relationship and review the patient's choice of setting and its visual impact on the screen to convey the unconscious dynamics.

The analyst's impression of Brent

 

Chapter Nine - Technology: Convenience and Therapeutic Leverage

ePub

Dina Oren (Israel and USA)

In recent decades, the world has become a global village and people move around within it frequently and over great distances. Alongside the distances crossed by people, technology has developed that allows us to maintain close contact. Texts and images get passed along in real time from one end of the world to the other. How do all these alter the meaning of closeness and distance? Intimacy? Do they open new options for therapy? Movement by therapists and clients around the world has created a need to keep tabs on the therapeutic relationship, and technology has made that possible, but is there really a need to carry on these existing relationships? Whose need is it? The client's? Or the therapist's? Perhaps it's our difficulty, as therapists, to separate from and frustrate our clients. Perhaps it's our feeling of omnipotence that we are irreplaceable? Complex and numerous questions surface, all of which relate in one or another way, to this issue: does the Internet provide sufficiently viable conditions for therapy in general, and analytical therapy in particular?

 

Chapter Ten - Screen Images: Transitional and Defensive Internet use among LGBTQ Adolescents and Adults

ePub

Andi Pilecki (USA)

The internet can be relationally adaptive when it is used as a transitional space (Balick, 2014; Dryer & Lijtmae, 2007; Naso, 2011; Pilecki, 2015). Within this transitional space, individuals from marginalized communities can access otherwise unavailable and much needed recognition and support; those who suffer from impaired self-esteem can develop greater social and sexual confidence; adolescents can find expansive opportunities to explore and experiment with identity; and socially isolated individuals can begin to build bridges to the outside world and toward a more flexible, empathic sense of self and other. Furthermore, the internet might be used as a relational venue in which to negotiate tensions between closeness and distance, schizoid and depressive modes of relating (Klein, 1946), and false and true blends of self-expression (Winnicott, 1956). Of course, internet use can also be defensive, characterized by idealized or false self-presentation, psychic splits and disembodiment, social isolation, and the derailment of authentic relational engagement in real life. The quality of internet use, whether transitional or defensive, is informed by the internal object relations of the user and by how that world is enacted online. These enactments invariably emerge in our consulting rooms as screen images or vignettes described by patients, and we use them as grist to the therapeutic mill. For now, let us look at some possibilities for relationally adaptive forms of internet use.

 

Chapter Eleven - Couple Psychotherapy Settings and Change in the Digital Age

ePub

Amita Sehgal (UK)

Electronic communication has a powerful impact on the way we conduct our daily lives. In this chapter I explore the influence of the digital revolution on our professional lives, in particular on the provision and practice of psychoanalytic couple psychotherapy. I attend to the importance of the setting within which psychotherapy is delivered over the internet and illustrate circumstances in which couple therapy was provided online. I discuss the advantages and disadvantages of providing psychotherapy online versus the traditional analytic setting. I conclude with my ideas on how transformational change occurs in couple therapy in which sessions are conducted in cyberspace.

Innovations in digital information technology represent a revolution that has fundamentally changed the way people think, behave, communicate, and work. Digital technology has made it possible to digitize information thus enabling words and images to be recorded in binary combinations of the digits 0 and 1, also called bits (Compaine, 2001). Digitizing information in this way has two advantages: large amounts of data can be compressed and preserved on small portable storage devices; and data transmission is speeded up. Through creating innovative ways of storing and disseminating information, the digital revolution has forged new ways of connecting people across geographical locations and time zones. Advances in mobile telephone technology, for instance, have now made it possible to use the cellphone to send and receive text messages and emails, make voice calls, and connect to the internet for activities ranging from accessing social media websites to online banking.

 

Chapter Twelve - Listening and Therapeutic Alliance Online

ePub

Lea S. de Setton (Panama)

This paper discusses the importance of listening in the analytic process. My purpose is to stress the effectiveness of teleanalysis as an alternative frame that is as valuable as in-person treatment. To support this idea, I review some research about human listening.

The auditory system develops very early, prior to the other senses. Babies can hear before they can see. Voices are sounds produced by the vibration of the vocal cords, and are internalized from the beginning of life. The word voice stems from the Latin vox, “voice” or vocare, “to call” (Merriam-Webster Dictionary). In traditional Ancient Greek, the voice was called “arrangement” or “condition.” The voice is the condition for the production of verbal communication. Sounds give voice to feelings and ideas. The tone of voice conveys a message about how the person is doing. The voice calls for a response.

Research has shown that learning begins in utero when the fetus is able to recognize sounds and speech patterns, mainly of the mother's voice. Babies are linked to their parents through a real audio-phonic communication system (Herren, 1971; Oleron, 1976 qtd. Anzieu, 1979, p. 27). New studies suggest that babies start to assimilate language inside the womb, primarily during the last ten weeks of pregnancy. They can listen, learn, and remember (Kuhl et al., 2013). Interestingly, they can hear the mother's voice because her body amplifies it.

 

Commentary

ePub

Caroline Sehon

We are given privileged access to the analytic journey between Alana, a thirty-year-old woman and Lea Setton, Ph.D., which began as a psychotherapy and transitioned eighteen months later into an ongoing psychoanalysis (three-times-weekly over five years). Usually, the analytic couple meets in the analyst's office. When the patient feels too incapacitated by depression to commute to the office, Dr. Setton offers Alana the option of telephone psychoanalysis.

Dr. Setton was dually trained at the International Institute for Psychoanalytic Training (IIPT) at the International Psychotherapy Institute and at Instituto Latinoamericano de Psicanàlisis (ILAP) in Panama. In the latter, she gathered an extensive repertoire of knowledge and skills in the fields of infant observation, neuroscience, and early development, applied to adult analytic practice, and, at the former, she is an ongoing participant in the IIPT teleanalysis research group. We learn that Dr. Setton values the therapeutic relationship as the primary agent of therapeutic action. In building this relationship, she is particularly interested in studying the way the body enters the consultation room through communicative language, including not only the spoken word, but also prosody of speech (rhythm, tone), vocal utterances, and silences. Dr. Setton is especially equipped to engage in attuned listening to the many dimensions of voice conveyed through analytic encounters on the telephone, and thus build a strong therapeutic relationship.

 

Chapter Thirteen - Thinking Ethically about Terminating Therapy after Trying New Technologies

ePub

Ernest Wallwork (USA)

As psychodynamic therapists have become increasingly comfortable technically and ethically with using online technologies for treating patients from afar, new ethical problems have surfaced that were obscured when such treatments were relatively rare. One of the most troubling of these emerging ethical issues arises when neither the therapist nor the patient realize that online treatment is causing more harm than benefit or that better alternative treatments are available than those being pursued.

Ethically, the therapist is the member of the dyad with primary moral responsibility for identifying and addressing problems with how well the therapy is succeeding. But online treatment offers so many advantages to both parties in terms of convenience, continuity of care, provision of services when nothing equivalent is available—and, for the analyst, maintaining a full practice—that the therapeutic dyad can end up colluding to avoid addressing the limitations of this way of working. Ethical problems arise when the convenience of jumping on a computer rather than going to an office or avoiding the difficulties of terminating and beginning again with a local provider prevent better treatment alternatives from being pursued vigorously.

 

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