Offline Therapeutic Technique
PSYCHOANALYSIS ON THE INTERNET: A Discussion of its Theoretical Implications for Both Online and Offline Therapeutic Technique
Paolo Migone, MD Psicoterapia e Scienze Umane, Parma, Italy
Psychoanalysis over the Internet is discussed as a means of reflecting on the way we think about theory of technique generally, and on what we mean by “communication” between patient and analyst. The way we think about online therapy has direct implications for the way we practice “offline” therapy. This problem is discussed from the point of view of the history of the theory of psychoanalytic technique, with reference to the classic 1953 paper by Kurt Eissler (K. R. Eissler, 1953, The effect of the structure of the ego on psycho- analytic technique, Journal of the American Psychoanalytic Association, Vol. 1, pp. 104–143) on “parameters,” and also with reference to the redefinition of psychoanalysis itself in terms of the analysis of the transference by the late Merton Gill (e.g., M. M. Gill, 1984, Psychoanalysis and psychotherapy: A revision, International Review of Psychoanalysis, Vol. 11, pp. 161–179). Online therapy is simply a different therapy, in the same way as two therapies, both offline (or both online), may be different from each other. The fil rouge that runs through this paper is a reflection on the very identity of psychoanalysis.
Keywords: Internet psychotherapy, Internet psychoanalysis, online psychother- apy, theory of psychoanalytic technique, parameters of psychoanalytic technique
It is a commonplace to say that the Internet is changing the way we communicate, and also the way we live, with repercussions that are not easily foreseeable. The worldwide web (www) is penetrating into every corner of our life, gradually changing ourselves and itself as it becomes more and more sophisticated in order to meet the most diversified needs. The importance of the Internet has been compared to the revolutionary discovery of the printing press.
Here I will take into consideration only one of the many possibilities the Internet can offer, namely as a vehicle for psychoanalytic therapy. But this paper will not deal with the
The author thanks Morris N. Eagle and John Kerr for their help in revising this paper. Correspondence concerning this article should be addressed to Paolo Migone, MD, Via
Palestro 14, 43123 Parma, Italy. E-mail: [email protected]
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Psychoanalytic Psychology © 2013 American Psychological Association 2013, Vol. 30, No. 2, 281–299 0736-9735/13/$12.00 DOI: 10.1037/a0031507
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http://dx.doi.org/10.1037/a0031507
clinical aspects of Internet therapy (a literature already exists in this regard). It will deal, instead, specifically with the theoretical implications of both online and offline therapy for therapeutic technique, and in order to do so it will necessarily discuss also the differences between the two therapeutic settings. It is argued that the way we think about online therapy has direct implications for the way we think and practice traditional, “offline” therapy. In other words, this paper will not deal with the question of therapeutic action or with the validity of online therapy. Internet therapy is only taken as a pretext—an excuse, so to speak—in order to reflect on theory of psychoanalytic technique in general, and also on the identity of psychoanalysis versus psychoanalytic psychotherapy. It should be clear that this paper is not a plea for the practice of psychoanalysis online. Rather, it aims at encouraging a reflection on theory of technique. Psychoanalysis on the Internet is not discussed as such in this paper, but serves as a reference point to consider theory of technique, in particular the way we conceive “communication” between patient and analyst.
Psychotherapy on the Internet has been referred to in many ways; for example, as online psychotherapy, telepsychotherapy, e-psychotherapy, etc., and it is a phenomenon that is rapidly growing. There are more and more web sites for counseling or for online psychotherapy, studies on the efficacy of this practice have been carried out, and so forth. In recent years, several psychoanalysts involved with the China American Psychoanalytic Alliance (CAPA, http://www.capachina.org) are experimenting with teaching, supervi- sion, and therapy with Skype to Chinese colleagues with the aim of helping the growth of psychoanalytic practice and culture in that country. (For discussions on the psychological implications of the Internet and on the interface between the Internet and psychoanalysis, see, among others, Turkle, 1985, 1995; Wallace, 1999; Bird, 2003; Akhtar, 2004; Ormay, 2006; Malater, 2007; Monder, Toronto, & Aislie, 2007; Dini, 2009; Cairo & Fischbein, 2010; Scharff, 2012; see also “Special issue on the Internet,” 2007, Vol. 94, Issue 1, The Psychoanalytic Review).
Technical Aspects of Internet Communication
The Internet allows us to connect and communicate with people who may live in any corner of the world at a very low cost, virtually for free, or, at worst, at the price of a local phone call. One may object that this happenstance is not altogether new, since the telephone already made this possible. In fact, in the United States the issue of “telephone analysis” was discussed at least as early as the 1950s (e.g., Saul, 1951). Commentators have variously considered telephone analysis a useful way to overcome certain resistances or impasses in the analysis, to replace missed sessions, to save time and reduce travel expenses in the case of long distances or when a patient’s handicaps limit movement, and when either patient or analyst move to another city and the parties do not want to interrupt an ongoing analysis.
What the Internet can offer, compared to the telephone, is the opportunity for a video-conference (e.g., with Skype). Thanks to so-called virtual reality, it is possible to simulate the session almost exactly. There are those who even simulate the waiting room. With audio and video synchronized in real time, it is possible also to duplicate the timing of interventions, silences, the length and times of scheduled “sessions,” and various other rituals as if both partners were in the office. Concerning privacy, sophisticated programs (such as those used by Internet banks) may encrypt communications (this is true especially
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