Psychoanalysis in the Technoculture Era

Alessandra Lemma, Luigi Caparrotta, Alessandra Lemma, Luigi Caparrotta

• Publisher: Routledge
• Year: 2013
• Print ISBN:
  9780415656726
  9780415656719
• Edition: 1
• eBook ISBN:
  9781135016852
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Alessandra Lemma - Winner of the Levy-Goldfarb Award for Child Psychoanalysis!

By now the internet and other forms of virtual communication have been in place for at least twenty years. However, surprisingly little has been written about the use of new technologies in the psychoanalytical literature. As such, Psychoanalysis in the Technoculture Era is a timely exposition on the subject of both virtual and analytic space.

Bringing together the work of several psychoanalysts, the Editors Alessandra Lemma and Luigi Caparrotta illustrate how new technologies have become an integral part of our everyday lives and how they have silently and subtly permeated the psychoanalytic setting. The contributors explore how new technologies have affected psychoanalytic practice and discuss the advantages and disadvantages of its use.

Psychoanalysis in the Technoculture Era unravels some of the meanings of virtual world terms, and opens this field to greater scrutiny, stimulating and promoting discussion about new technologies in psychoanalytic practice. This book will be of interest to the psychoanalytic community including psychotherapy professionals, psychoanalysts, post graduate, graduate and undergraduate students.

Chapter 1

New technologies and the psychoanalytic setting

Andrea Sabbadini

Once upon a time, back in the 1970s, bulky answering machines started to expand the range of our telephone facilities. I well remember the resistance of many analysts, myself included, in accepting that such devices could also be useful for exchanging messages with our patients, say about the cancellation of sessions. The debate about the intrusion of technology into our clinical work, centred then on the appropriateness or otherwise of using audio or even video recordings of sessions for training or research purposes, became extended to the one concerning new telephone technologies.

Of course, answering machines, not unlike everything else, could be used for defensive goals, such as in order to avoid a more personal verbal interaction (‘If you need to give me a message outside a session, you may at least make the effort to tell me in person!’). From our current perspective, however, such a justification sounds weak, and we can hardly imagine any therapist today objecting to the practice of leaving or receiving voice messages – though such therapists would still want, whenever appropriate, to interpret their patient’s motives for using this form of communication – or, indeed, for refusing to do so.

The landline telephones in our consulting rooms, meanwhile, have been to a large extent replaced by mobiles and smartphones, which also offer the facility of exchanging written text messages (in addition to voice ones), now used as a norm between analysts and patients but, again, at first resisted by many colleagues for analogous reasons (‘If you need to leave me a message outside a session, you may at least make the effort to do so with your own voice!’).

Come the 1980s and many of us began to indulge in the expensive habit of acquiring personal computers. We could not then have predicted, however, the extent to which their development would have eventually affected our professional work – in the area of research with the help of large databases of information, such as PEP and Wikipedia, and of powerful search engines, and in our clinical activities. In particular, the easy and ever-faster access to the Internet since the late 1980s, with its website and email facilities, has revolutionized the way in which we operate as psychoanalysts, the way in which we relate to our patients (and they to us) and, as a corollary, the way in which we conceive of our own professional identity.

Nowadays the impact of new communication technologies is felt by all psychoanalysts and psychotherapists, including those who may be unable or unwilling, for a variety of reasons, to make much use of them. I consider such an impact on our work to be fundamentally positive. Although some aspects of it are a source of concern, for instance the increased difficulty to preserve the confidentiality of clinical material, I believe that those in our profession who object in principle to technological progress, like the Luddites had done in the nineteenth-century textile industry, are self-defeatingly destined to be left behind. But especially in these first decades of the electronic revolution there is a price to be paid, often before we can make available to us the intellectual and emotional resources to pay it.

Software, cyberspace, teleconferencing, laptops, DVD rewriters, digitalization, webcams… In the course of hardly one generation a whole vocabulary has entered our worlds and everybody has had to familiarize him or herself (some more successfully than others, of course) with a vast number of new words, ideas, objects and activities. An enormous, but steadily dwindling, population has thus come into existence of what Prensky (2001) has called ‘digital immigrants’: those who, myself included, grew up before the new electronic technologies were developed, in contrast with the new generation of ‘digital natives’, familiar since their childhood with the language of computers, video games and the Internet, and more comfortable than most of us with establishing and maintaining relationships from a distance through social networking sites. Who still remembers having a ‘pen friend’?

Such a process has involved a loss of competences, and the need to replace them with alternative ones. Because of the speed of the electronic revolution, these enforced changes and readjustments have often been experienced as traumatic, including by psychoanalysts. A number of unconscious defences, such as denial, have been mobilized to deal with the confusion thus engendered in our sense of professional identity.

That the rapid development and increased availability of such communication technologies is having, for better or worse, a major impact on most aspects of our everyday life is an unquestionable truth. In our work, electronic mails and SMS have to a large extent replaced letters and telephone conversations, making the exchange of ideas and information among colleagues, members of committees and administrators faster and more efficient. At the same time, these media are also being used by patients and analysts to communicate with each other about matters such as the rearrangement of sessions. This may affect the maintenance of analytic boundaries and therefore the nature of our relationship with patients.

About a year ago I received an email from a Mr D. He was asking for a consultation because he had decided, as he put it, ‘to embark on an analysis’. I replied by giving him my mobile telephone number so that he could call me up to make an appointment – which he did. Several SMS from him followed – to change the date of our meeting because he had suddenly decided to take a holiday, to check my address, to confirm the new date of the consultation, etc. Having finally arrived on the right day, at the right time and in the right place, Mr D called me up again from outside my front door to check that the bell he was going to ring was the right one.

In the course of the consultation Mr D confessed that he had already ‘Googled me up’ and was pleased to have discovered that I had published articles on cinema and psychoanalysis as he had himself a great interest in films. He also informed me that he would be available to attend only one weekly session, something that I explained I was not prepared to do as I see my patients more frequently. Mr D insisted it was me he wanted to see. As I could not comply with his request I referred him to a colleague – something which, feeling rejected by me, he only reluctantly accepted.

A week later I received an email from Mr D with a link to a website: the advertisement of a company offering discounted Viagra, Cialis and other such pharmaceutical products. Having overcome my initial surprise (and, I must add, considerable annoyance), I reasoned that Mr D must have felt powerless to obtain from me what he wanted (‘embarking on an analysis’) and projected his own impotence onto me, to then present me with a cheap chemical solution to ‘my’ problem.

The reason why I am reporting this vignette is to make the point that none of this – contacting me by email, leaving SMS texts, checking my credentials on Google, sending me a link to an Internet website – could have happened only a few years ago.

My specific concern in this chapter is about the impact of new communication technologies on the psychoanalytic setting and, in turn, about how such an impact may affect our analytic attitude and, more generally, our analytic identity.

I will consider here what changes to our classic setting are required to allow psychoanalytic supervision or therapeutic sessions to be carried out with the help of electronic devices; how our attitude towards supervisees and patients may be altered by such changes; and how our own sense of who we are (what we believe in, and what, why and how we do it) is influenced as a result – to such an extent, perhaps, that our analytic identity may end up being transformed also when we happen to resume working in our usual, more conventional ways.

For many years now psychoanalysts have been engaging in telephone supervision and analysis (Bassen 2007 ; Leffert 2003 ; Zalusky 2003). At first this was done in order to deal with the problem of candidates living too far away from any training analysts to be able to attend sessions in person, sometimes because a recognized psychoanalytic society did not exist yet in their own countries; the only way for these candidates to train was therefore to do so from a distance, i.e. over the telephone. This practice, sometimes referred to as ‘teleanalysis’ (Scharff 2010 and this edition) or ‘distance analysis’ (Carlino 2010), was extended to situations where either patient or analyst had to move abroad or to a different city for work or family reasons (a development made more impelling by the increasingly frequent phenomenon of geographical mobility) and the only way for the analysis, originally taking place in the consulting room, to continue was to conduct it over the telephone. In these cases, sometimes the analyst recommended that meetings in person would also take place, if only sporadically, for the two participants in the analytic couple to remind themselves of what it feels like to share the same physical space. On a more short-term basis, telephone meetings would replace the more conventional ones when patients undergoing analysis became affected by an illness or had to move temporarily to a far-away place for work reasons, thus being prevented to attend their sessions in person.

All these situations have persisted over time and, from what I can infer from the relevant literature and from informal conversations with colleagues, have in fact become more frequent as well as acceptable to a growing number of practitioners. In the last few years, though, distance psychoanalysis has been spreading also as a result of choice rather than necessity, with patients opting for meeting in cyberspace even when they could have easily done so in the consulting room – a questionable practice because of the likelihood that its main purpose is to circumvent resistance to the in-person analytic process. In other words it is not invariably so, but we need to remain open to the possibility that it is being used as a form of resistance.

The ever-more common practice to conduct psychoanalytic and supervision sessions over the telephone, or even by email (see Gabbard, this edition; Carlino 2010), has been a source of considerable debate. Some authors would claim that ‘the present state of modern telecommunications … must be taken as a new opportunity to allow for the implementation of analysis beyond the walls of the psychoanalyst’s office’ (Carlino 2010, p. 3), thus much increasing its accessibility. Others would find it ‘difficult to accept the argument that psychoanalysis, or we psychoanalysts, have to chase after the changing times and society. Our task’, they point out, ‘is to understand and interpret change’ (Argentieri & Amati Mehler, 2003, p. 18).

I shall limit myself here to explore some of the implications for the analytic setting, attitude and identity of sessions carried out by such video-links as Skype: a more sophisticated means of communication than the telephone, more compatible with our conventional ways of practicing psychoanalysis and, besides, more likely for these reasons to become widespread. I shall introduce the neologism ‘skypanalyis’ to refer to such practice.

As most readers probably know, Skype is the video conferencing software programme that allows those engaging in conversation to also watch each other on their respective computer screens. Importantly, Skype also shows your own image in a corner of the screen: a small mirror, in effect, which may acquire special significance in the context of the therapeutic setting where normally, in the absence of mirrors, people cannot see themselves.

It must be said that Skype technology, at least in its present state, is far from flawless: for instance, the sound of the voices may become distorted or lose its synchronicity with the images, and the video may at times freeze. Furthermore, if in the course of a session the Internet connection on either side gets interrupted, the communication (and therefore the session) is also discontinued – a frustrating and not infrequent occurrence. Which fantasies are then likely to be activated? Was the interruption deliberate? Will it be restored, and if so when? What changes to the setting should be brought about to deal with it? Should the time that had been missed out for analytic work during the interruption be made up at the end of the session for it to have lasted its full 50 minutes?

Related to these issues, at least as far as the fantasies that could be evoked are concerned, is the often-encountered occurrence of silences in the course of a session. When the two participants in the analytic couple communicate from a distance, silence on either side can feel more difficult to tolerate than it would if they were in the same room. This is because silence, especially when visual contact is not available, may be experienced as threatening, making it more likely to get broken prematurely in an attempt to prevent the emergence of anxieties of abandonment or persecution. These can take the form of paranoid fantasies such as doubts about whether the other person is really being silent, or if the analysis is being carried out by telephone, that the analyst has instead left the room, got distracted doing something else, or even perhaps dropped dead. Poland pointed out that patients in his office ‘sometimes ask “Are you asleep?” but on the phone they ask “Are you there?”’ (quoted by Bassen 2007, p. 1034).

Another consideration is that, unlike in sessions taking place in a consulting room, during video-calls the bodies of the two participants only share a virtual space, also known as cyberspace. There is no doubt that the physical presence of the analyst’s and the analysand’s bodies plays an important part in their interaction, with repercussions on the transference and counter-transference. Is it then possible to thus dispose of bodies, or rather of their actual presence in a physical space, without this having major implications on the analytic process? How will their absence alter the quality of the communication between the analytic couple – indeed, any couple?

It is true that patients using the couch have only a few brief moments to look at their analysts at the beginning and the end of sessions, and analysts sitting in a chair behind their patients only have limited visual access to their bodies. It is also true that physical contact between them is mostly non-existent, and that other perceptual modalities (such as smell) only rarely come to play a significant part in the analytic relationship. However, the mere possibility of, say, bodily contact between them, be it of an erotic, affectionate or aggressive nature, is central to the experience (both actual and transferential) that therapist and patient have of each other. The absence of such possibility in skypanalysis, therefore, is not a matter of indifference.

We may add that although in the virtual space of distant analysis the two bodies of analyst and patient are not simultaneously present in the same location, we now have to factor in a third presence replacing, as well as representing, them: that of the electronic machinery (computers with their microphones and cameras), which at least in the first few sessions, before those using them get accustomed to it, cannot but disturb the intimacy and privacy of the analytic relationship. This interference will often have all sorts of connotations, including in the area of Oedipal fantasies, possibly stimulating curiosity, jealousy and persecutory anxieties. None of this, it could be argued, is a bad thing in itself, but it does require careful handling and interpretation. In this respect Yamin Habib comments that:

the analyst’s acceptance of the involvement of a permanent third party in the relationship – even if the third party is an instrument – modifies the conventional setting so drastically that it is appropriate to consider whether the resulting process diverges substantially from psychoanalysis as such.

(2003, p. 26, my emphasis)

The answer to this question, it seems to me, depends on our definition of ‘psychoanalysis as such’.

Should the conventional analytic setting of couch and armchair be somehow replicated when sessions occur by video-call? Should skypanalysis be set up in an asymmetrical way, so that the camera is only switched on in the patient’s room (allowing the analyst to see him), but not in the therapist’s? The analyst would then be sitting in his/her consulting room’s chair with her laptop in front of her showing her analysand on the screen, while the patient would be lying down on a couch in his own home, analogously as he would have done if he were in the actual presence of his therapist, perhaps with the webcam placed behind his head to give the analyst a similarly limited view of him. Such an artificial setting, mimicking the more usual analytic one, can easily lead to distortions in transference and counter-transference dynamics. A preferable arrangement would be for therapist and patient engaged in

skypanalysis is to sit in front of their computers with both webcams switched on, thus reproducing the face-to-face setting – not an ideal arrangement, of course, but perhaps a worthy compromise if it allows psychoanalysis to take place at all between participants otherwise living too far from each other to meet in person on a frequent basis.

It is crucial to acknowledge that relationships and communication taking place in a physical space are fundamentally different from those happening in cyberspace. Any denial of such differences and attempts to reproduce the classic setting in the kind of virtual reality where distant sessions occur are doomed to failure. For instance, the importance of the temporal dimension in psychoanalysis, and the peculiar coexistence of its timeless quality with the presence of rigorous time boundaries (Sabbadini 1989) is even more prominent in skypanalysis: this is because the same 50-minute time shared by the two protagonists on such a psychoanalytic stage replaces, so to speak, the physical space they would have occupied had they engaged in classic analysis...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Contributors
• Foreword
• Acknowledgements
• Introduction
• 1. New technologies and the psychoanalytic setting
• 2. Cyberpassion: E-rotic transference and the internet
• 3. Clinical issues in analyses over the telephone and the internet
• 4. Psychic development in a virtual world
• 5. An order of pure decision: Growing up in a virtual world and the adolescent’s experience of the body
• 6. “A perfect world” and its imperfections: Psychoanalytic clinical notes on adolescence and virtual reality
• 7. Internet offenders from a sense of guilt
• Index