Psychoanalysis Online 4

Teleanalytic Practice, Teaching, and Clinical Research

Jill Savege Scharff

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781138312418
• eBook ISBN: 9780429857140
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Psychoanalysis Online 4: Teleanalytic Practice, Teaching, and Clinical Research brings a systematic, qualitative research perspective to the question of the effectiveness of teletherapy, teleanalysis, and teleteaching. It suggests that, contrary to some traditional arguments, effective treatment, teaching, and supervision can take place remotely; that affect and imagination are more important than physical presence.

Providing theories of therapeutic action as well as philosophical reflections, the book features examples of online clinical cases, including crisis interventions by email, and aims to stimulate openness to innovation, responsible process and review. Each contributor presents their clinical qualitative research and survey study findings. The Bernardi Three-Level Model, developed for assessing therapeutic change in the traditional analytic setting, is applied to the study of teleanalysis with different patients. It is found that, in videoconference or even in email communication, the sense of closeness in the therapeutic encounter does not depend on physical proximity but on integrity and commitment.

The book concludes with research findings on the effectiveness of videoconference compared to in-the-classroom settings for teaching psychodynamics, supervising psychotherapy, and conducting psychotherapy with Chinese students. It will be of great interest to a variety of professionals and researchers who practise remotely, with particular relevance for those situated in the fields of psychoanalysis and psychotherapy.

Chapter 1
Assessing the scope and practice of teleanalysis

Preliminary research findings

Janine Wanlass

Technological advances, the increasing mobility of the work force, financial constraints, and use of social networking media to traverse geographically distant spaces are changing the worlds of the analysands we treat. In concert with these rapid sociocultural changes, greater numbers of psychoanalysts are utilizing technology to maintain contact with their analysands, providing sessions by telephone, Skype, or video connection systems to sustain the frequency, depth, and continuity of psychoanalytic treatment. Additionally, technology provides potential access to analytic treatment for analysands who reside in areas where analytic training and experienced analysts are absent, opening a world of possibility and greater choice in treatment options. While some construe the incorporation of technology in analytic treatment as progress, others voice criticism that technology compromises analytic process and interferes with the development of transference dynamics. These are interesting speculations; however, little is known about the practice and experience of “teleanalysis”, or conducting psychoanalysis through the assistance of the telephone or other high quality video connection system. For the purposes of this research project, teleanalysis refers to a psychoanalyst engaging a patient in analytic treatment at a minimum of three times weekly with at least some portion of their analytic sessions occurring through the use of technology.

Although some anecdotal reports exist about teleanalysis practice (Leffert, 2003; Lindon, 2000; Scharff, 2010, 2011, 2012, 2013a, 2013b), empirical studies are relatively scarce in the psychoanalytic literature (Gordon, Wang, & Tune, 2015). With this deficit in mind, a research group composed of psychoanalysts and academic researchers designed a three-stage research project to assess the scope and practice of teleanalysis, funded in part by a research grant from the International Psychoanalytical Association (IPA) and approved by the Institutional Review Board (IRB) at Westminster College. In gathering research team members, care was taken to include psychoanalysts familiar with psychoanalytic theory and technique and researchers with established expertise in clinical research methodology.

In this chapter, I will present the preliminary findings from stage one of this research effort, involving analysis of questionnaire data from IPA analysts and candidates about their use of technology in clinical practice. Additionally, I will outline our plan for stage two of this research, where we will gather interview data from a subset of the responders to stage one. This qualitative research component will expand our understanding of the quantitative findings. The last stage of our intended research effort incorporates outcome data from analysands, a much more complex enterprise still in the planning stage at this point in time. Drawing from the data gleaned in stage one, this chapter concludes with a discussion of the study limitations and implications for further research and clinical training in the teleanalysis field.

Research question

What is the nature and scope of teleanalysis practice? Describing the characteristics of current teleanalysis practice represented the first step in our research process. To address this question, we gathered descriptive data about how, where, and by whom teleanalysis is currently practised. Specific areas of interest in our investigation were drawn from discussions in an ongoing Teleanalysis Study Group, hosted by the International Institute for Psychoanalytic Training (IIPT) and originally an international working group of the IPA (Scharff, 2011).

In our research, we expected to find that technology was frequently used to conduct analysis, with combined in-office and remote sessions appearing more commonly than remote-only analysis. We speculated that the most common reasons for use would be analyst or analysand travel, a preference for an analyst in a different geographic location, or limited options for analysis in the analysand’s geographic area. We presumed that technical difficulties, challenges in understanding nonverbal communications, and issues with emotional containment would present the strongest obstacles in practising teleanalysis. In the United States, concerns about licensure and HIPAA compliance might rank high among the list of deterrents.

Overall, we predicted that most users of teleanalysis would rate it as nonequivalent to in-office sessions but find it a good alternative when in-office sessions were not feasible. We hypothesized that users of teleanalysis would rate it as efficacious, while non-users would see it as a break in the frame, ineffectual, and too compromised to substitute for in-person work.

Measures

To assess our research questions, we developed a 15–20 minute, 23-item questionnaire composed of multiple choice, Likert-scaled and open-ended questions. Items were based on input from a combined team of psychoanalysts with the clinical expertise to identify relevant content areas and measurement experts with the necessary methodological expertise to construct effective questionnaire items and analyse empirical findings. The questionnaire was piloted on a small group of English-speaking psychoanalysts and revised to correct problems in wording, scaling, and understanding. The questionnaire was translated into Spanish and French to gather the largest possible participant sample and to reflect different training and practice paradigms represented in the membership of the IPA.

Questionnaire items included demographic information about the analyst or candidate, such as age, years in practice, and geographic location of their practice, to help us describe our participant pool and assess the potential impact of cohort effects on opinions about and use of technology. For example, are younger analysts who have grown up with technology more comfortable with employing technology in their practice? Another section of the questionnaire examined types of technology used, frequency of use, and factors influencing decisions to use technology. A sample question was, “In your opinion, what is the most compelling reason to offer analytic sessions through technology? Please describe.” Responders were asked to indicate whether they used telephone or videoconferencing and whether they conducted analysis entirely via technology or in combination with in-office work. The final section of the questionnaire assessed the perceived impact of technology on analytic process, challenges encountered in using technology such as difficulties managing crisis situations or technological malfunctions, and estimates of the treatment efficacy of teleanalysis compared to in-office work.

We gathered questionnaire data from both practitioners and non-practitioners of teleanalysis. Practitioners answered all items, while non-practitioners responded to the demographic questions and offered opinions about the efficacy of teleanalysis practice.

Participants

Research participants were recruited from IPA member analysts and candidates via an email communication distributed by the IPA, describing the purpose of the study, requiring completion of an informed consent agreement, and providing a link to the online survey in the language of their choice. Descriptive statistics were used to capture the sample characteristics. Our response rate was lower than anticipated, comprising 341 responses or only 6 per cent of the population surveyed. Respondents represented 50 different countries, with Europe, South America, and North America each accounting for approximately one third of the sample. The United States, Brazil, Argentina, and Italy were the countries with the highest number of responders, irrespective of population. Seventy-three per cent of the participants responded in English, 30 per cent in Spanish, and 7 per cent in French.

The average age of study participants was 60.5 years, with 68 per cent of the sample falling between the ages of 49 and 71. T...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• Permissions and acknowledgements
• About the editor and contributors
• Introduction
• 1 Assessing the scope and practice of teleanalysis: Preliminary research findings
• Commentary
• 2 Teleanalytic sessions for sudden immobility
• 3 Sadomasochistic constellation and distance analysis
• Commentary
• Commentary
• 4 Case study research: A psychotherapeutic relationship established by email
• Commentary
• 5 Psychoanalytic process in cyber-technology
• 6 Proximity and distance in teletherapy
• 7 Technology and private practice
• Commentary
• 8 Research on teaching, supervision and psychotherapy using video conference technology
• Commentary
• 9 The effect of distance training on the development of psychodynamic psychotherapists
• Commentary
• 10 Psychoanalytic teaching by video link and telephone
• Index