There are challenges to long-distance therapy. But it also allows sessions to take place from anywhereby Anna Blundy / October 9, 2017 / Leave a comment
Walking the dogs with a psychoanalyst on Hampstead Heath (I know, I know). “But what if the connection fails?” he asked, and I admitted that it quite often does. “Do you interpret it?” he wanted to know. We both laughed, but sometimes I do. I say; “It’s quite hard for us to connect to each other today.” More laughter, muddy black labradors, Alastair Campbell on his run. Melvyn Bragg on his walk. Autumn leaves.
We were talking about Skype, the highly unorthodox medium via which I now see a couple of my patients. Years ago, I was in a supervision group at that hospital in Kings Cross that used to be the Hospital for Tropical Diseases (my dad once tried to check himself in with self-diagnosed cholera on return from covering conflict in Southern Africa and was told to go home-—he’d been drinking too much coffee, smoking too many cigarettes and not eating enough). Someone in my group was seeing an acutely agoraphobic patient via Skype. There were sharp intakes of breath, pleas to be open-minded from the group leader, fumbling embarrassment from the transgressive therapist. But her weekly reports were pretty much the same as those of the rest of ours, transference included.
Not picking up on the transference and countertransference is the biggest potential problem with long-distance therapy. So, with apologies to everyone in the field, this means the unspoken relationship between patient and therapist, the things projected and potentially introjected. Very simplistically, aspects of the transference might be revealed by the question: How does the patient make me feel? If a patient is unconsciously angry the therapist might start to feel angry. The therapist will hopefully say, “I think you feel angry,” rather than acting out and expressing anger towards the patient.
So, when one of my patients moved to a remote area in the Middle East where English-speaking psychotherapy is not an option, I suggested we continue via Skype. The sometimes unbearable intimacy of being in a small room with someone experiencing extreme emotions is, as you’d expect, somewhat lost. It isn’t as intimate as face-to-face therapy, it just isn’t. Silences can be just that—silences. It’s far harder to catch the meaning behind a silence through a screen. This, in my case, results in wordier sessions. I cut in sooner with a “What are you thinking about?”…