Quarterly Magazine of The American

Psychoanalytic Association
Digitalizing Psychoanalysis
and Psychotherapy?
Possibilities and Downsides
Jose A. Sa porta
The Internet and video conferencing allow
us to offer psychoanalysis and psychotherapy
to previously inaccessiblepatients.The tremen-
dous enthusiasm of psychiatrists and psychol-
ogistsin China to learn psychoanalyticconcepts
and to experience psychoanalytic treatment is
matched by the enthusiasm of many American
clinicians with the China American Psychoan-
alytic Alliance (CAPA) to make supervision
and treatment availableto the Chinesethrough
SKYPE,an Internet video conferencing software
program. The American Psychoanalytic Asso-
ciation has approved long distance psycho-
analysis conducted over SKYPE as a fourth
case for certification and for analytic immer-
sion. At the Boston Psychoanalytic Society
and Institute we are considering ways of offer-
ing our one-year fellowship in psychoanalytic
psychotherapy to the Chinese over SKYPE.
I have been pondering the exciting possi-
bilities-and possible downsides-of expand-
ingthe reach of psychoanalytic psychotherapy
and psychoanalysis to a very different culture'
with the useof technology.As I havementioned
Jose A. Saporta, M.D., is assistant
director of the Advanced Training Program
in Psychoanalytic Psychotherapy at the
Boston Psychoanalytic Society and Institute,
an advanced candidate, and on the faculty
of the Center for Psychoanalytic Studies
at Massachusetts General Hospital.
this to others, I have noticed that some re-
spond with enthusiasm while others instinc-
tively recoil. These two poles in people's
reactions may reflect two opposing views on
the effect of technology and more generally
the effect of physical context and space on
subjective experience.
What isthe effect on patient and therapist
of conducting a psychoanalytic treatment over
SKYPE?One possible danger of attempting
such an intimate human encounter through this
medium came home to me while listening to
a discussion on an NPR radio program about
KINDLE, the electronic device sold by Amazon
for downloading and reading books. Literary
and cultural critic, Sven Birkerts of Boston
University, argued that this electronic medium,
as opposed to reading the printed page, so
alters the subjectivity of readingthat it can have
more far-reaching con-
sequences for the very
structure of subjectivity.
In The Gutenberg Ele-
gies.' The Fate of Reading
in an Electronic Age,
Birkerts writes about
the subjective and cul-
tural impact of chang-
ing the source of our
information from the
printed word to a digi-
tal electronic medium.
Continued on page 8
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''lN1f!j' (]~JJ n7/,7J - "'ll!)'(]~"
In Treatment
Two Viewpoints. 20-21
All-Pervasive Guilt. 23
After the Storm. . . 27
THE AMERICAN PSYCHOANALYST Volume 42, No.2 Spring/Summer 2008
SKYPE
Digitalizing Psychoanalysis
Continued from page I
There are innu-
merable physical
gestures and rit-
uals around buy-
ing, opening, and
reading a book.
An encounter
with a book can
be a full-bodied
experience--tac -
tile in feeling its
weight and tex-
ture, smell of the newly printed page, sight in
the texture of the page and style of the print,
cradling the book to read it in our favorite
chair. The rituals and gestures around the act
of reading place one, according to Birkerts, in
a state of reading. He writes,' 'I value the state
a book puts me in more than I value the spe-
cific contents."
It is not a long shot to suspect that such
physical rituals can influence the subjective
impact of the book. Cognitive scientists and
linguists are coming to a new appreciation of
Freud's body ego in their recent emphasis on
embodied cognition. This is an appreciation
that the experience of the body in motion and
the body's encounter with the world structure
the way we think and the metaphors and
language through which we conceive of our-
selves and the world. There is evidence that
the influence of the body and physical context
is not limited to early development but has an
ongoing influence on the structure of thinking.
Jose A. Saporta
Theories of embodied cognition add a di-
mension to conceptualizing the differences
between psychoanalysis and psychotherapy,
in which physical context, physical rituals,
and different boundaries of physical space
may be significant to the experiences of each
treatment modality.
CONSULTING ROOM
OR COMPUTER SCREEN
One can imagine that psychotherapy and
psychoanalysis affect the structure of subjec-
tivity in part through repeated physical gestures
and rituals and physical space. We see, smell,
and feel as we approach the office. We are
greeted and cross the threshold and enter
sound and sight are digitalized as opposed to
analogical. Voices come over the speakers
with a slight, subtle lag between movement of
the lips and the matching sound. I have noticed
that on SKYPE one is unable to maintain eye
contact. To appear to the other person as if
you are looking them in the eye you have to
look into the camera, which is just above the
screen. You cannot look at the person and in
his or her eyes simultaneously.
What does one lose over the computer
that is available when we share the same space
in an office? Is attachment the same without
physical presence? Is affective information
equally available? Are we present to each
other and to the experience in the same way?
Physical contact is possible but proscribed in the actual
office, but not physically possible in virtual space. Does this
not alter the experience of the wish and its modulation?
the space using our legs, and sit or lie down in
the way we have done innumerable times
before in that space and in other spaces in
our lives and our past. The physical space is
bounded. It is the therapist's space we come
into, and we experience that space through
all of our senses. This physicality and bodily
encounter with the space is the background
for what transpires affectively and linguistically
between therapist and patient.
Now consider patient and therapist going
to separate computers and turning them on.
Rather than walking to the door and crossing
the threshold we
type instructions
on a keyboard or
click a mouse. The
space is bounded
by a screen. The
patient does not
enter the physical
space of the ther-
apist but stays in
his or her own
usual surround-
ings. Beyond con-
scious perception
is the fact that
Would the sense of containment be the same
with virtual boundaries as with the physical
boundaries of the office? Physical contact is
possible but proscribed in the actual office, but
not physically possible in virtual space. Does
this not alter the experience of the wish and
its modulation? The physical presence of both
parties presents the possibility of enacting
one's fantasies. The words may be the same,
as well as most of the music, the nonverbal
dimensions of speech, and body language. But
how do the differences in physical and sensual
experience, ritual and boundary affect the
subjective impact of the conversation?
The encounter with the space in which psy-
chotherapy takes place is not just physically
immediate. In Culture and Human Develop-
ment, cultural-developmental psychologist
Jaan Valsiner describes a culturally mediated
space where cultural meanings direct our
attention and physical encounter with the
space. Valsiner writes:
We can talk about demands that the
meaningful nature of a particular
structured environment sets up for
persons' feeling, thinking, and acting.
Continued on page 9
8 THE AMERICAN PSYCHOANALYST Volume 42, No.2 Spring/Summer 2008
/
SKYPE
Let us call these settings semiotic
demand settings (SDSs):human made
structures of everyday life, settings
where the properties of the objects
are codetermined by perceptual-
actional and cultural meanings-based
possibilities and expectations.
Understanding the role of the physical space
in which treatment takes place must includethe
cultural meanings of the space and how rt con-
nects with other culturally arranged spaces
and to the culture as a whole. The therapist's
office and the Intemet are very different cultural
spaces,or different "semiotic demand settings,"
with different relationshipsto the overall culture,
which guide attention and action or our
encounter with the space in different ways
and with different subjective consequences.
EXPANDING CONTEXTS
But perhaps I underestimate the power of
human identity and subjectivity to adapt and
cross into new and expanded media and con-
texts. Such is the view of philosopher and
physicianRayTallis.He reminds usthat in 1850
Wordsworth believed that includingillustrations
into written text in newspapers would infantilize
us and,"drive us backto 'caverned life'sfirst rude
career.' " According to Tallis,Worsdworth, " ...
felt that the endless influx of news from daily
papers would incite usto a level of unbearable
over the last few decades has not
fundamentally altered the way we
relate to each other. Love, jealousy,
kindness, anxiety, hatred, ambition,
bitterness, joy, etc., still seem to have
a remarkable family resemblance to
the emotions people had in the
I 930s. The low-grade bitchiness of
office politics may be conducted
more efficiently bye-mail, but its
essential character hasn't changed.
Teenagers communicating by mobile
phones and texts and chat rooms
and webcams still seem more like
teenagers than nodes in an elec-
tronic network. I have to admit a
little concem at what we might call
the e-ttenuation of life, whereby
people find it increasingly difficult to
be here now rather than dissipating
themselves into an endless electronic
elsewhere; but inner absence and
wool-gathering is not entirely new,
even if rt is now electronically orches-
trated. It just becomes more publicly
visible. What's more, there is some-
thing reassuring about electronic
technology: Because it iswidely and
cheaply available and because it is
so smart, it allows us to be dumb,
and so compresses the differences
between people.
Theories of embodied cognition add a dimension to
conceptualizing the differences between psychoanalysis and
psychotherapy, in which physical context, physical rituals,
and different boundaries of physical space may be
significant to the experiences of each treatment modality.
-:
restlessness." For Tallis it is the rate of change
that is important and when gradual enough our
experience of self canappropriate ever-expand-
ing mediums, contexts, and spaces.In his article
"Enhancing Humanity" published in Philosophy
Now, Talliswrites:
The dramatic electronification of
everyday life that has taken place
Human identity begins by appropriating its
own body and, given time, can appropriate
expanding mediums and spaces. Tallis con-
cludes, "The essence of human identity lies in
this continuing self-redefinition. And if we
remember that our identity and our freedom
lie in the intersection between our imper-
sonal but unique bodies and our personal
individual memories and shared cultural
awareness, it is difficult to worry about the
erosion of either our identity or our free-
dom by technological advance."
I view psychoanalysis and psychoanalytic
psychotherapy as one way to preserve
human subjectivity and relatedness against
dehumanizing cultural forces. It would be a
boon to cultures such as China's that are
undergoing such massive and accelerated
change. But, does the Internet and digital
information dehumanize, or does it extend
the range of human relatedness? By using
the Internet and video conferencing to offer
psychotherapy and psychoanalysis to more
patients, does psychoanalytic psychotherapy
succumb to and even become an agent of
these dehumanizing, digitalizing forces? Or
will our essential humanity and the essence
of the analytic encounter assert itself in ex-
panded and more varied spaces?I would like
to say that we will see, but when we as psy-
chotherapists enter and adapt to this new
space offered by the Internet our own sub-
jectivity may change aswell, so that we may be
unable to see its effect. We can see the effect
of this new space only from outside of it,
from our traditional space. I suppose we will
have to see as best we can.
* * *
I thank Alan Pollock for helpful comments.
~
Editor's Note: This artide, in abbreviated
form, will appear in FOCUS, the Boston
Psychoanalytic Society and Institute
newsletter.
THE AMERICAN PSYCHOANALYST Volume 42. No.2 Spring/Summer 2008 9