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In order to work with the appropriate feedback of the psychoanalytic community a Survey has been released to all IPA's psychoanalysts (candidates and members) of all IPA's regions. Survey addressed matters ranging from their involvement (or rejection) in remote therapy praxis up to IPA'S members and candidates assessments on the use of converging technologies in online treatment of patients. The purpose of the survey wasn't purely statistical; it was also qualitative aiming to gather the experience of the surveyed analysts, disregarding they have performed or not online therapies, related to matters such as the feasibility of interpreting transference without on-site interaction of gestures and symbolisms. Without the help of our colleagues from all over the world it would have been impossible to fulfill our objectives. 
​We thank all respondents. Survey's reception of answers closed on October 12, 2014. Here are the results:


INTRODUCTION

The survey on Remote Psychoanalysis was released by the Remote Research Team coordinated by Dr Analy Werbin and distributed by the IPA to all members and candidates. We thank the IPA for that valuable help that allowed us to reach IPA’s members and candidates from all over the world.

UNIVERSE Y RESPONSE RATIO:

IPA’s total universe of members and candidates was 15,319 professionals at the time of releasing the survey.
Emails successfully sent by the IPA accounted a total of 13,143, meaning 85.8% of the total of members + candidates. Those sent but unsuccessful were due to reasons such as mailbox full, anti spam protection, and wrong addresses.
Opening rate was 37.8%, a total of 4,981.
Survey was answered by 1,171 analysts, representing 7.7% of the total of IPS’s members + candidates, un 8.9% of the analysts that actually received the email, and 23.5% of those who received and opneed the email. These percentages are slightly higher than the answering rates IPA has when sending mailings to members and candidates. According to the criteria and objectives of the research, we concluded that the responses achieved is a representative sample of the total universe, apt to identify attitudes and trends towards remote psychoanalysis:

Universe (N) = 13,143
Sample (n) = 1,171
Population standard deviation (pq) = 0.5
Confidence interval (Z) = 95%
Sampling error (e)= 2.7%

The sample is representative enough of the universe: when drafting the survey our goal was achieving an error no larger than 3% with a confidence interval of 95%, which would have mean 950 samples. Responses received (1,1171) exceeded our goal decreasing therefore the error to 2.7%

CUANTITATIVE RESULTS:

Demographics
Samples received by country compared to the respective universes.: Distribution is very similar among countries ranging from 8% to 15.5% (mean 7.7%). Some Latin American countries such as Uruguay, Brazil and Argentina, were below the mean of responses. The following chart shows universe and percentage of response of selected countries representative of the overall results: 

Country           Members & Cand        Responses          Percentage

UK                              451                        70                       15.5
Canada                      392                        41                        10.5
France                       792                        82                         10.3
Spain                         433                        40                           9.2
US                          3,223                       271                          8.4
Italy                        1,002                         84                          8.4
Mexico                      437                         36                          8.2
Germany                1,231                         98                          8.0
Uruguay                    220                         14                          6.4
Argentina               1,620                         80                          4.9
Brazil                     1,801                          78                         4.3

Profession of respondents:
Physicians: 45% (of those, 68% psychiatrists)
Psychologists: 55%

When answering how many years were the respondents working as analysts, results were coherent with an issue that is a current worry within the IPA: the aging of the membership population. We believe this aging could be a constraint for the more intensive use of new technologies, and the use in a more trendy use fo technological means in remote therapies.:

(years working as analysts, in percentage of the surveyed universe):

1-3: 7.1 %
4-5: 5.1 %
6-10: 11.2%
11-15: 11.8%
16-20: 13.0 %
21-25: 16.8%
+ 25: 35.7%

Regarding the response distribution segmented by members and candidates it was concluded that there was a lesser interest in answering the survey by the candidates as compared to the response rate of the members. Effectively, being the population of members / candidates 72% / 28%, response was 86% / 14%.

Computer and smart phone usage
(the following figures refer to general usage, not necessarily exclusive usage in the office with clients or colleagues)

Almost the entire universe use some kind of computer device, PC or Tablet. The universe with no PC or Tablet is less than 1%. 66% of the sample use Windows PC, 41.5% use Mac, and iPAD and other Tablets are used by 48.3%. Smartphones are used by 91.5% (iPhone 53.2%, Android 18.2%, phones with Windows OS, 6% Blackberry 5.4%.

Video conferencing, chat, and social networks’ usage:

Video conferencing is used by  67.2% of the sample: Skype is used by 53.9, while 13.9% use other video conferencing systems.

Chat and interactive instant messaging (such as Whats App) on mobile phone are used by 26.8%. Chat on PC (Facebook, Google) is used by 13.9% of the universe.

13.5% of the respondents to the survey have a website, while 21.5% have a Facebook account and 6.6% a Twitter account.

Usage of technological means for remote analysis:

Have used: 62.2%
Have used a mix of remote and ‘in room’: 7%
Have never used: 37.8%

Of those who have used:
By eMail: 8.0%
By Chat: 1.6%
By Phone: 48.9%
By Video conferencing: 55.0%
Mix of two or more different media: 4.1%

QUALITATIVE RESULTS

When asked the personal opinion regarding how the perception of the position of the IPA’s component society towards the question ‘should remote analysis be performed as a valid psychoanalysis?’:

14% perceived that the component society was in favour,
40% opined that the component society was against,
30% indicated that they believe it is being under stydy
4& are indifferent to this subject,
and 12% has no opinion.


Almost the same percentages applies to the perception of how the component society agree or disagree with the use of remite analysis in training and supervision.

NOTE: When the survey was released the IPA’s Policy on Remote Analysis in Training, approved by the Board on December 2014 and posted in the website on February 2015 was unknown to us and therefore no opinion on that Policy was asked. You can see that Policy clicking here.

Asked about the personal opinion regarding the question: Is Remote Analysis a Psychoanalytical Therapy? the survey indicated the following results:

NO: 41%
Are studying it: 25%
YES: 34%

To assure consistency of data some cross-check questions were included, refining the previous answers:

Of the 41% that indicated NO, remote therapy is not psychoanalysis, 22% of the sample indicated that if the session is not ‘in room’, meaning remote, it is not psychoanalysis, while 19% indicated that they have to think about it and make further studies and assessments.

Those who did answer YES, remote therapy is psychoanalysis:

24% opined that the remote therapy can be used at any given situation as a valid alternative to the traditional ‘in room’ setting, while 71% indicated that it should be used only in special circumstances, such as travel, living in a place where there a re no IPA analysts, illness or disability that impedes travelling to the office of the analyst, change of residence and willing to go on with the same analyst.

Opinion about the future:

64% of the sample (no matter if agreeing with remote analysis or not) opined that remote therapies are unavoidable in the near future, while 33% of the sample said it is avoidable and shouldn’t be used as an alternatve to ‘in room’ setting in any circumstances.

Legal matters:

Analysts from some countries, specially US and other English speaking countries, believe that there are certaing legal barriers to work in a different state or province than the one that has issued the practicing license.

34% of the sample think it may be no legal to practive in another country / state, and 24% of the sample believe that even if it not illegal, there might be a problem of coverage by the malpractice insurance.

When analysing ethical issues, 93% of the sample believe that a special care has to be taken into account if doing remote analysis due to potential  identity theft, specially when using video conferencing without camera, email or caht, and telephone.

Free Comments:

A total of 8,480 comments were received and taken into account for the research. The list of comments that follows if a short selection of opinions regarding pros and cons of remote analysis, that can help the reader to get a feeling of the trends in this matter:
(comments are unedited – some comments were translated from French, Portuguese, Italian, Spanish, and German)

My patients never loss a session. When they can’t come to the office we communicate by different media such as phone or Skype.

Exceptional sessions for very fragile patients, mostly in the first year of treatment, in case of patient's or my own departures.

Remote therapy. This is not really psychoanalysis but psychotherapt, only to be used when a client moves to another location, and always for a short time.

It is psychoanalytic psychotherapy.

I do not think it has to be done.

I supervised by phone and mail or fax + presencial sessions but do not have the experience of treatments in distance, except for my home patients whenever necessary, pregnancy or broken ribs for exemple.

I use telephone mostly and most analysands prefer it to Skype.  This is mixed in with in person one to three to four times per year. One with Skype who is not in analysis. I use email in between sessions as needed but it is not a substitute for a session of course.  It is to communicate admin matters or sometimes to discuss something unsaid or difficult to say.

I don' t think it is ethical do do distance psychoanalysis.

I use the phone for discussing sessions with American colleagues. In cases of emergency I use phone or e-mail to provide contact for patients, but not on a regular base. When as analysts we talk about "presence" or about the patient "being alone in the presence of the other", the other needs, in my view, to be present in person, not only with his/her voice. Only once I helped a very disturbed patient to "bridge" a hospital stay by having daily phone sessions with her.

I only had psychotherapy consultations when a patient temporarily moved to another country, It is a flawed medium, for I do not see the patient in its entire body, I do not see his natural body language, I do not have his smell (yes, smell is one of the important - almost forgotten by us humans - media of knowing an object),it is like once jokingly a woman said about the use of condoms: to use condoms is like to suck a wrapped candy. No personal, direct contact.

I use both Skype and phone but only when continuation of an ongoing treatment makes that necessary

i do not use phone or email for treatment . They are  less secure than Skype

Because I am absolutely against it. I do not believe that psychoanalysis is just "interpretation", the psychoanalyst is required to be present in "flash and bones" and "pay on his own person" (Lacan)

The face to face interaction is important in human relatedness.

I do not find it feasable in terms of my other professional committments. I also have reservations how analytic the remote treatments are and what is the setting disruption caused by remote contact.

I do not perform distance psychoanalysis (high frequency of sessions on the couch), which I consider impossible, but do perform distance face to face psychotherapy, which is possible and sometimes quite enriching.

This practice - distance psychoanalysis is not allowed here, in Brasilia - Brazil Psycoanalisis Institute.

There has not been any need for that so far and I also doubt the possibilities of using technology in psychoanalysis proper. In psychoanalytic psychotherapy it is a different matter.

Not likely to do this as it would feel too remote. I already feel the world is losing something in terms of direct human contact through the advent of such technology and I anticipate this will have deleterious consequences for humanity.

I have one analytic patient (in same state) is by phone and another analytic patient (in another country) meets with me by Skype.

My experience is that Skype offers the most convenient form of communication in treatment, regarding visual (video) and audio components. During the session often both - analyst/patient - are using headphones with microphone, in re-created  standard setting (patient lies on the couch, patients computer is behind his/her head and camera is directed toward couch);analyst can observe patients body and gestures, same as in the standard analytic setting. It is doable without headphones as well.

I have offered psychoanalytically  informed psychotherapy and supervision via telephone, I do not believe you can do psychoanalysis long distance. In most instances, I have offered telephone contact to finish up an intensive therapy process when the patient moves to other locations. I agreed to work with a patient once from the beginning. She flew in at intervals for intensive in-office therapy. I supervise Doctoral students and professionals via phone when necessary.

I would think that such a setting will have a profound influence on unconscious phantasies difficult to analyse and should be used only with intense care and supervision in order to examine these interferences.

I do not practice psychoanalysis proper remotely, but I do practice psychodynamic psychotherapy by telephone with a patient who cannot come to the office.

I feel psychoanalysis CANNOT be practiced in a remote fashion. Many arguments could be said but one remains principal: there must be an effort from the patient in such a geographical travelling searching to be analysed.

The analytical situation as described by Freud is not possible unless both parties are in the same room together.

I have patients who can’t attend to the consulting room. I think that that kind of Treatment should be done when you have no alternative. For me something important is lost when you don't have the interpersonal contact of two people in the same room.

This survey does not define "psychoanalysis" as to number of sessions for example.  I do what APsA prefers to refer to as psychoanalytic psychotherapy because it is 3 times per week and it is through CAPA.  I consider it psychoanalysis, although it would also not be acceptable as such at my institute where I am both President and a Training and Supervising Analyst.

Remote setting is in many aspects differs from in-room analysis; another application of the analytic method, such as when we change to group analysis. It requires changes in the analytic attitude and understanding to such which are coherent with that setting. Contrary to the (to-day rarely used) technical concept of parameters, in case of remote analysis to many parameters change and we cannot solve them after a time. Therefore it needs special training which I do not have.

I do not agree with distance psychoanalysis. I believe too much data is lost in the lack of physical presence.

I think it is not appropriate in a scientific research to speak about "distant psychoanalysis"! You take something as given which is not yet proved! I know of no serious research on the transference-countertransference implications on attempts of distance psychotherapy!

1)I believe remote psychoanalysis is incompatible with the basic frame and method of psychoanalysis. 2)Electronic communications are not secure so confidentiality is probably impossible. 3)I worry about liability when I can't actually see the patient and assess them.

Remote communications are tolerated for supervision of candidates working out of France

In both Moscow study groups (MGP, MPS) keep strictly negative attitude towards training-analysis by Skype, but have to admit necessety in supervisions via Skype (or others apps).

I live in a city (Cali) different from where the Institute is (Bogota), therefore part of the training was designed to be conducted via skype: seminars and supervision BUT the analysis needed to be conventional and was conducted with the training analyts in town 4 times per week.

Very 'traditionally' oriented Training Institute, and even without any kind of explanation why modern technology can't be used in treatment when indicated (distance or patients inability/disability to be physically present); which is very strange considering the fact that our profession 'promote' function of thinking. However, it is historically well known fact that strong initial resistance toward change is always followed with adaptation, especially when talking about Psychoanalytic field.

I do analytic training in China conducted by USA analysts via Skype.

Only in cases of otherwise impossible treatment I would consider a 'remote Analysis', or - with hesitation - involuntarily interruptions like illness or moving to another country. For supervising, there is rather a lot of positive experience in the Eastern-European training. The training Analysis by 'shuttle analysis' was a positive experience from both sides, but also rather 'heavy' to endure.

Divided sentiment.  Common skepticism.  A complex issue, ideosyncratic, with political overtones. Those who most object are most like to have no experience with Skype to my knowledge.

Remote analysis is not a legit psychoanalytic therapy!

Canada is a big country,with few large centers where psychoanalysis is available. People working in the northern parts of the country in the oil fields etc. have no choice if they want psychoanalysis or psychoanalytic psychotherapy than to do it at a distance.

I have no clue about the SPI, I know the BPAS are investigating the subject but the list of members using Skype seems to have been stuck for a long time.

My Institute has not taken a position that I am aware of (LAISPS). I was supervised in the case mentioned above using Skype for one summer.

APsaA has been opposed to this modality for faulty reasoning.

A number of my colleagues in the American Psychoanalytic Association fully agree with remote analysis.  Many do not agree.  A much smaller number support remote analysis of candidates. Lectures and classes for candidates by remote media are widely used. My particular society is rather accepting of supervision by remote media, if the supervisory dyad could not otherwise meet.

My Institute has a remote site of our Institute in another state (Oklahoma)where we've been training analysts;  faculty travel there; candidates travel to our site.  We have just admitted a candidate in another state who will fly here for classes, some face time w/ analyst, some analytic sessions by phone.

Our society, of which I am President,  has yet to really address these issues. It tends to decide them on an individual basis and has made decisions in favor of Skype analysis when it is a short term section of a general face to face analysis.   There is great skepticism by many as to its efficacy.

The face to face psychoanalytical psychotherapy should respect the usual ethics of psychoanalysis like of course neutrality. If the question concerns psychoanalytical setting (patient lying on coach): the necessary regression required in this setting needs a presence not only a voice - or a virtual image - the tendency to be more in a "secondary process register"  and act or being not neutral is a great danger - that's why I don't agree with distant couch setting.

I do not believe an analyst can enter the complex state of mind, including free-floating attention, co-dependant of neutrality, when so many technological "interfaces" and "glitches" make the "in the room "person to person relationship impossible.

The question is not whether this attitude 'should' be applied, but rather how, if so, it can be operationalised in different settings and contexts. Remote psychoanalysis would appear, at first sight, to facilitate neutrality but the opposite might in fact be the case. New social media re-create distance and intimacy conceptions at a different level.

However, distance psychoanalytic psychotherapy, since the analyst's and the patient's bodies are not present to express the wealth of paraverbal information that bodies express, sometimes requires the analyst to be somewhat more active.

I prefer the term abstinence ! Since there can be no neutrality in case of necessity to set parameters (in the sence of Kurt Eissler),f.e. during suicidal crises. But the need of activity (like asking) has to be analysed afterwoods. Distance analysis should be seen as parameter and should be analysed, if not focused by the patient, then by the analyst. (which would be the next parameter, why the analyst has to focus these circumstances)

It is an essential technical rule in Analysis. Modifying analytic treatment to distanc analysis should strongly consider fundamental analytic technique requirements for they are essential quality of successful analytic treatment. Analytic Technique should not be modified in distanc analysis. Any unwarranted modifications of analytic technique should be considered as unjustified and oddly 'borderline' and the outcome of treatment would be highly questionable. We have to preserve the quality.

Anything but neutrality removes the treatment from the psychoanalytic domain.  This applies regardless of the geography of the treatment.. face to face or distance, neutrality continues to define an analytic treatment.  In psychotherapy, one may deviate from an analytic stance for patients with ego deficits that require this for their progress.  Adapting the treatment to the patient applies when trting at a distance or face to face.

The format of the analysis should not alter the analytic attitude.

Neutrality is one of the attitude that distinguish   psychoanalysis and psychoanalytic psychotherapy from the other approach. If we are not able to protect neutrality in different settings, as remote treatments,  we should not call them psychoanalytic.

It is a real problem: Neutrality is an important attitude but  applied to distance where some perceptions signs are absent, there is a risk to change the dynamic of the treatment and there is a risk or a nessecity to be less neutral.

This "neutrality" should be applied to distance psychoanalysis but, in my opinion, it is very difficult to realize.

I think this is one of the main things lost by distance analysis; not just body language but the emotional and physical atmosphere in the room

The on-going unconscious process between patient and analyst require, within the frame, the full involvment of all levels of psychical functioning from the most secondary and "cognitive" to the most bodily (see Winnicott : "I work with my body-ego). This only has a chance to be realized, sometimes, when both protagonists of the analytic process are effectively in presence, bodily, in the room. The dynamics of regression, in particular, cannot be elaborated "remotely".

Unconscious infraverbal signs and sighs are in many cases the only cues for working through archaic traumata in borderline patients, working "at the limits of the [psychoanalytical] method (Botella, C. & S., 1988). I do not believe that such work is anyhow possible distantly, without two bodies present in the same physical framework.

I agree that it is quite a reduction in this sense but face to face by Skype is still a situation that gives much of the reality of the encounter (de la rencontre) where this dimension still takes place (facial expressions, movements, etc-)

In remote analysis, the body is present, but in a different way.

If you know a patient well, countertransference will find its way to develop even via the phone (even via e-mail). The question might be: Is it possible to work as well with transference-countertransference if the communication is remote and not person to person, because there might be a much stronger possibility of misunderstanding each other.

This is the main reason why I am against any form of distance psychotherapy or psychoanalysis. It is not an embodied realtionship but something else, a strange pseudo - contact, a kind of cognitive (visual and auditive) expierience that does not have anything to do with the real, emootional exchange with another person.

There are elements but the fundamental problem is the analyst's counter transference and capacity to do free floating attention. There are fundamental unconscious elements of communication via the presence of two bodies.

There are too many obstacles - including rough disturbances in Internet connection - in distant sessions for the analyst to read body language as well as feel the atmosphere of communication.

I believe there are ways to make this true (body language in distance therapy). It would depend on some technological factors (such as brandwidth and connection quality in order to have better video, for instance) and some technical factors (what position the patient is in, the framing of camera when doing video sessions, etc). Such are technical issues for study.

On Skype with the computer behind the patient, and when the patient begins and ends the session facing me i have the same view of his face and body as in a local analysis. i also believe that analysts differ in their awareness of body language, tone, word choice etc

Remote interaction using new technologies is about 'disembodied' interaction, insofar as the body is removed from immediate observation. The use of a camera is a proxy but it only taps on one sense (vision). Furthermore the camera itself encourages 'posing'.

We need more study about that to undersdant how this interaction is going to happen in a distance. For sure a lot of new things will appear.

In traditional setting analysands lie on the couch.  So called body language is the sight of the top of the head and feet and occasionally hands.  Absurd to think that analysts, sitting behind patient, are somehow watching their body.  Analysts look into middle distance and listen deeply.

The analyst needs to pay attention to the signals that are available, and they may be different in the two different settings.

Distance analysis has to have essential audio-video quality of communication which allows the analyst and the patient to work with transference/countertransference in the distance analytic treatment. Lack of video quality in this treatment would significantly influence the quality of analysis and disable essential adequate transference/countertransference development in treatment.

The non-verbal communications are less available to the analyst/therapist, but they do exist  The demand on the observational skills of the analysts may be greater in order to perceive the non-verbal.  Perhaps we need to develop training in perceiving and interpreting non-verbal communications for distance trtment.  Phone and email are so restricted in this way, I do not use them for trmt.  Phone only on occasion when absolutely necessary and email never.

There are abundant signals on Skype, facial and otherwise.  Depending on placement of the camera, the patient may be better seen on Skype than in the office except for the patient's entering and leaving.

I was severely skeptical of the effect of absence of such bodily communications in telephone analysis.   However, having successfully terminated a full several years 4x/week analysis I am astonished how successfully individuals find alternate, even tone of voice or breathing pace, ways of eliciting and evoking reactions, of engaging in nonverbal communication.

Visual contact is just a way to contact the patient feelings. We need to observe the others components, like smells, body position, and how and why the patient choose the chair instead the coach.

I think that by setting up the computer so that the analyst has eh same view of the patient as she has in the office much of the movement, position on the couch could be viewed.  IN face to face work no verbal expressions are perceived, but perhaps the more subtle might be missed.

Countertransference should be about unconscious communication. This is likely more powerfully communicated in the nonverbal register with remote analysis.

I would say that it depends which mode of communication you are using, visual i.e skype or telephone.  I think it depends on the patient, and that it would still be preferable to be seen in person as the subtleties are more likely to be picked up by each person.

Tones of voice, silences, etc all can affect the transference/countertransference. Nontheless, the range of information is more limited in phone sessions and I think they should only be used when no other arrangement is possible, or to continue a treatment that is well underway and began in person.

In my experience the patient comes to use the medium in analogous ways, and there is often quite intimate exposure to the body language and elements like the patient's breathing pattern.

Skype allows for seeing the patient and the patient seeing the analyst. It is possible to perceive different tones of woice and even body movements over the phone, to some extent. It is, however, a loss of information not see see but it does not make psychoanalysisi impossible and transferences to actualise in the interaction. I cannot perceive that psychoanalysis could function via E-mail.

I'm skeptical.  I do not know if distance analysis will allow for all the nuance and subtleties of communication that occur when analyst and analysand are together.

The situation is less intimate and free

Distant analysis activates different psychic spaces of the patient. There is a topological difference between free association of the traditional setting and talking at distance.

If free association is not possible then distance psychoanalysis is not either.  Distance and different media make free association more difficult but not impossible in my experience. All depends on the setting agreed to by both analyst and patient.

Patient free associates and analyst evenly hovers attention. This method is the same whether by phone or in person.

If you cannot choose a media that permits free association it is not psychoanalysis anymore..

Just as the free association can be used with the analysand on the couch or in the chair or walking around Vienna, so too it can be use in distance treatment sessions.  One patient I had some years ago who had to switch to phone sessions due to illness found it easier to engage in free association on the phone than she had on the couch.

I believe free association is very much possible in video, and somewhat possible by phone. E-mail or other text communication would surely be harder.

Hard to imagine this being an equivalent experience nonverbally as opposed to verbally.  I think it possible via Skype but would struggle to call it 'free association' by email when the process of communicating the stream of consciousness to the analyst is so different as well as no pauses, intonation, etc...

The free association technique is the patients analytic attitude and does not depend on the form of treatment, depends more on the therapeutic relationship.

i do think longer silences are less viable at a distance as one becomes anxious that the connection may be lost

A patients comment was "When I am in your office I do not see you, now it is hard"  It is different, we have to be able to adjust our how we hear, and try to grasp those non verbal ways the patient has and also our own reactions anc countertransference.

My opinion is that "free association" can happen all the time, even outside the setting. We always watch it for instance during supervisions. I think that the all the contact inside the mind (thoughts, connections, ideas) is free to happen despite the external environment.

Whether the patient's communications occur in person or in distance analysis, free association may or may not, equally, occur, as long as the patient has a quiet environment within which to work or will work on why they have not provided that for themselves.


Free assoc requires a safe room, can this be arranged in distant locations?

Some free association is possible, but it will be limited and distorted (especially associations in the transference) by not being in the presence of the analyst.

"Free association" is a basic instruction that can never be fully complied with.  The treatment is, in large measure, about the non-compliance - unique to each patient.  I see no likely difference with distance psychoanalysis, save that we have somewhat limited information.

Free association in analysis is a goal, not a technique.  There are always interferences with the process.  In distance treatment, in my experience, free associations are less useful; of course, I don't practice distance analysis, only psychotherapy, so "guided associations" are more likely, in any case.

It is difficult with patients who never had any direct experience of psychoanalysis. depends more on media on is choosing. The patient may develop some doubt whether analyst is listening to, interested in what he is talking about and may lose interest in therapy at all.

It is not possible if the media used enables to cancel what has been written...then it would be fake...but when the media allow free talking, I think it could be possible

I think that working at a distance should be studied as something new, without using concepts already established. Virtual relationships are different from personal and are still unknown.

Someone may feel safe for free associating but only because of the real distance between him and analyst. Closeness and fear of it may be avoided and not being analyzed.

I would have to say that, as much as there surely is a phenomenon of transference, it is not of the same quality (but not necessarily worse) as it would be if the session was face to face.

Transference exists. Countertransference is more intensive, countertransferencial  acts are much more possible. There is also technological transference â€" countertransference relation which is very difficult to be analysis.

it will be such a phenomenon, like in all possiblle relations between human beings, but I think that will have nothing to do with those present in a traditional setting

It is clear that 'analytic space' is timeless and spaceless and therefore fundamental analytic phenomena is developing as an inevitability  of analytic interaction.

Transference and countertransference always exist, but to whom, and what it means is a different story, and probably much more difficult to grasp in the remote situation.


My experience is clearly that it can and does. The means of gathering one's countertransference are more limited, though.

Transference and countertransference are natural part of a relationship, whatever the setting.

Remote analysis is not a legit psychoanalytic therapy!

The phenomena are universal characteristics of human interaction.  The specifics may be less workable in remote analysis.

Isn't the phenomenon of online dating proof that first edition fantasy material can be projected onto anyone?  Please.

In some ways, Skype makes the hotting up of the transference easier on patients.  They will sometimes feel overwhelmed by their impulses when they're back in the room, where they feel like grabbing, kissing, biting, what have you.  Of course, the screen/remote/distance aspect complicates matters, too.  The screen is a "third," between the dyad that cannot be forgotten.

Transference and countertransference may INTENSELY  occur in the distant psychoanalysis, I think it exagerates and turns this element virtual, subject to acting out, and fantasies, Out of the reach of the perception of the analyst.

The transference and countertransference are concepts specific to situations that occur between psychoanalyst and analysand in the psychoanalytic process in office .

What happens in the relationships between people in other situations must have other names and concepts.

I think that they can occurs but not in the same form

I think the risk is rather that such transference reactions are more difficult to hold or contain at a distance if they are intense.

We can built a setting, including Skype and work with free association, the unconscious, transference and countertransference once it had been established beforehand.

T and CT they certainly occur but are somewhat different and at times weaker

Transference and countertransference are ubiquitous human phenomena. They don't stop when remote electronic communications. The issue to address is not whether they occur, but whether it is harder to notice them and to address them remotely than in person. I could see where for dyads in person might be more effective and for others remotely might be better.

The very interest in making phone calls and naming them as "psycho-analysis" is a direct sign of unanalyzed counter-transference impulses, wholly unconscious to people who act-out them through this kind of thing, with rationalizations of "distance", and "technology". You must be reminded of the unsucessful attempts to do "remote surgery", in the area of medicine, now more a trick dign of a circus presentation or of vaudeville theaters.

If transference and countertransference were so fragile that it DIDN"T develop easily, there would be no need for psychoanalysis.

Because the analysand is not in the room, he/she will say things on the phone much more readily than in-person.  Access especially to the negative transference is deeper and more complex.

Why not? Is not it an everyday phenomenon as well? We communicate unconsciously with other people, we have phantasies about them and transfer on them our different feelings. Is it a reason for or justification of the validity of distannt psychoanalysis? I think not.

Both are universal, and occur within therapy and without. What you mean to ask, then, is whether T and CT an be identified and interpreted in remote as well as in traditional PsA. And that, clearly, depends on the analytic couple in question more than on the modality.

 “If there had been no railway to conquer distance, my child would never have left town and I should need no telephone to hear his voice.”
Sigmund Freud, Civilization and Its Discontents 

Remote Therapy Research

A research on distance psychoanalysis