ArticlePDF Available

What are the characteristics and concerns of high and low raters of psychodynamic treatment to Chinese students over VCON?

Authors:
  • Indepenent Practice

Abstract

In an earlier study, Gordon, Wang and Tung, (2015) surveyed 176 therapists, supervisors and teachers in the China American Psychoanalytic Alliance (CAPA) and found that the psychodynamic constructs hold up well when treating Chinese patients over video-conferencing (VCON). Over-all, expert raters felt that psychodynamic treatment over VCON was only slightly less effective than in-person treatment. However, 30% of the therapists in this survey had strong feelings against VCON treatment. In this study we asked what differentiated low raters from higher raters of treatment effectiveness. This study focuses on the 94 therapists, who completed the survey questions on treatment issues. As hypothesized: gender and profession (psychiatrists, psychologists, social workers, and others) were not significantly related to how therapists rated the effectiveness of treatment over VCON. Also as hypothesized: the number of years doing therapy and number of years using VCON were also both not significantly related to how therapists rated the effectiveness of treatment over VCON. As hypothesized, low effectiveness raters and higher raters significantly differed on all the questions regarding specific psychodynamic variables over VCON: symptom reduction, exploring mental life, working with transference, working though relational problems, working with resistances, privacy concerns, and countertransference (p < .001 for all these variables). Low raters felt that exploring the mental life of the patient was most affected by VCON and working on transference was least affected by VCON. Never the less, low raters of effectiveness and higher raters of effectiveness generally agree that treatment over VCON is valuable since it offers quality treatment to underserved or remote patients, and it is valuable when the patient is house-bound or travel would be impractical. The few who were most critical of treatment over VCON were perhaps comparing it to the more familiar psychoanalytic condition rather than considering new ways to extend psychodynamic thought and services.
What are the Characteristics and Concerns
of High and Low Raters of Psychodynamic
Treatment to Chinese Students
Over VCON?1
Robert M. Gordon, Jane Tune, and
Xiubing Wang
Abstract
In an earlier study, Gordon and colleagues (2015), surveyed 176 therapists,
supervisors, and teachers in the China American Psychoanalytic Alliance (CAPA)
and found that the psychodynamic constructs hold up well when treating
Chinese patients over videoconferencing (VCON). Over-all, expert raters felt
that psychodynamic treatment over VCON was only slightly less effective than
in-person treatment. However, there were a small number of therapists who had
strong feelings against VCON treatment. In this study we asked what differenti-
ated low raters from higher raters of treatment effectiveness. This study focused
on the ninety-four therapists, who completed the survey questions on treatment
issues. As hypothesised, gender and profession (psychiatrists, psychologists,
social workers, and others) were not significantly related to how therapists rated
the effectiveness of treatment over VCON. Also as hypothesised, the number of
years doing therapy and number of years using VCON were also both not signif-
icantly related to how therapists rated the effectiveness of treatment over VCON.
As hypothesised, low effectiveness raters and higher raters significantly differed
on all the questions regarding specific psychodynamic variables over VCON:
symptom reduction, exploring mental life, working with transference, working
though relational problems, working with resistances, privacy concerns, and
countertransference (p< 0.001 for all these comparisons). Low raters felt that
exploring the mental life of the patient was most affected by VCON and working
on transference was least affected by VCON.
Nevertheless, low raters and higher raters of effectiveness generally agree
that treatment over VCON is valuable since it offers quality treatment to under-
served or remote patients, and it is valuable when the patient is house-bound
or travel would be impractical. The few who were most critical of treatment
over VCON were perhaps comparing it to the more familiar psychoanalytic
conditions rather than considering new ways to extend psychodynamic thought
and services.
Key words: online psychodynamic psychotherapy, China American
Psychoanalytic Alliance (CAPA), videoconferencing (VCON) treatment.
Psychoanalysis and Psychotherapy in China, Volume 2, 2016: pp. 86–96.
6-Gordon_OPUS_7_1.qxp copy.qxp 31/08/2016 13:49 Page 86
Psychological treatment over the internet with videoconferencing (VCON)
extends services to many underserved populations around the world.
However, we know little about how VCON psychodynamic psychother-
apy differs from in-person (or embodied) psychodynamic psychotherapy.
Backhaus and colleagues (2012) looked at sixty-five studies of video-
conferencing psychotherapy (VCP). They found that VCP has been used in
a variety of therapeutic formats and with diverse populations, is generally
associated with good user satisfaction, and is found to have similar clinical
outcomes to traditional face-to-face psychotherapy.
However, it is possible that the more the treatment depends on a thera-
peutic relationship, as in the case of psychodynamic treatment, the more
there may be problems with online treatment. Bayles (2012) states that
Skype can be a productive asset to psychoanalytic treatment. However,
Bayles, is concerned that physical proximity is a factor in the psychoana-
lytic situation. She writes that technology could limit access to the kinds of
vital information that our sense modalities contribute to the analytic
process.
Sucala and colleagues (2012) reviewed the literature on “E-therapy” and
found of the 840 reviewed studies, only eleven (1.3%) investigated the
therapeutic relationship. Cognitive behaviour therapy with less emphasis
on the working alliance and more emphasis on technique with cognitive
learning as the goal, would seem to be a natural treatment for the internet.
Empirical studies support this. Johansson and colleagues (2013) report
studies showing no differences between internet-delivered cognitive
behavioural therapy and in-person cognitive behavioural therapy for mild
to moderate depression, anxiety disorders, and somatic problems.
Although psychoanalysis and psychodynamic treatment require more of
a therapeutic “presence” than other psychotherapies, there remains the
question of how much the internet filters the interpersonal psychodynamic
constructs.
Berle and colleagues (2015) administered a survey to fifty-five patients
asking them to rate their preferences for various forms of therapy delivery
including treatment over the internet. Not surprisingly, the results suggested
that patients overwhelmingly preferred individual face-to-face therapy.
Scharff (2013a) cited a study by the American Psychoanalytic Association
that found that 28% of analysts reported using the phone, 9% using Skype
for psychotherapy, and 4% using Skype for psychoanalysis. Scharff states
that online supervision and online analyses are part of the repertoire of
current practice; and, when used with care, the internet has the potential
to allow teaching and treatment to occur when it would otherwise be
impossible.
The issue of privacy with providing treatment online is another area of
debate. Churcher (2012) was concerned that in the virtual environment of
PSYCHODYNAMIC TREATMENT TO CHINESE STUDENTS OVER VCON 87
6-Gordon_OPUS_7_1.qxp copy.qxp 31/08/2016 13:49 Page 87
cyberspace, we have less knowledge about our immediate physical and
social environment to make reliable judgments about whether a conversa-
tion is private. However, Scharff (2013a) replied that we need to work on
weighing the benefits against the risks with teleanalysis. She argues that
there will be fewer concerns when there is more discussion at our associa-
tion meetings, and more systematic research as to whether teleanalysis can
provide a secure setting and can meet the standard of being clinically
equally effective.
Skype and most other videoconferencing services offer privacy with the
use of varying degrees of encryption. HIPPA (Health Insurance Portability
and Accountability Act of 1996) compliance however, is another matter if
there is electronic billing for insurance. For example, Skype is not HIPPA
compliant since it does not notify clinicians when security breaches occur
and because it does not claim to be so. Other VCON services such as VSee
and Zoom are HIPPA compliant and do immediately report any breach of
personal health information.
Paolo (2013) feels that online therapy is simply a different form of
therapy than standard psychoanalysis. Dettbarn (2013) discussed Skype as
a third “secret sharer” in the analytic process. She wondered what feelings,
fantasies, and thoughts analyst and client entertain when they experience
each other over the internet. Dettbarn brought up questions about the
absence of spatial and physical proximity and the development of trust,
denial of the reality of separation and mourning, internet as a protec-
tion against the real dangers in a physical presence (violence, aggression,
sexual seduction), and if transference, resistance, and regression will seem
more magical.
The less sense of propinquity in treatment may be why, despite the effec-
tiveness of online treatment, there might be a higher drop out rate as com-
pared to in-person treatment as reported by King and colleagues (2014).
Caparrotta (2013) claims that digital technologies need to be embraced
responsibly and with an open mind by the psychoanalytic profession. This
seems to be occurring as indicated by three recent books on the topic,
Psychoanalysis Online: Mental Health, Teletherapy and Training, and
Psychoanalysis Online II, both edited by J. S. Scharff (2013b, 2015), and
Psychoanalysis in the Technoculture Era edited by Lemma & Caparrotta,
(2013). J. S. Scharff’s (2013b, 2015) books emerged from an international
workgroup of colleagues from the International Psychoanalytical
Association (IPA) and the International Institute for Psychoanalytic Training
(IIPT) studying the practice of psychoanalysis and psychotherapy con-
ducted on the telephone and over the internet.
Fishkin and colleagues (2011) reported on teaching and treatment
offered by the China American Psychoanalytic Alliance (CAPA), which
provides treatment, education, and supervision to Chinese mental health
88 ROBERT M. GORDON, JANE TUNE, and XIUBING WANG
6-Gordon_OPUS_7_1.qxp copy.qxp 31/08/2016 13:49 Page 88
professionals over the internet. They discussed the success of the pro-
gramme and how the cultural issues as well as aspects of the transference
and countertransference are shaped by the virtual nature of the technol-
ogy. D. E. Scharff (2015) reported that another psychoanalytic distance
learning institute, the International Psychotherapy Institute has also had
great success in the use of videoconference technology.
Recently, in a special issue of the round robin newsletter entitled
“Working electronically”, Lynch (2015) expressed the concerns about
working online. Lynch wrote that he was involved with the Sino-American
Continual Training Project for Senior Psychodynamic Psychotherapists. He
wrote,
There are two obvious benefits of providing psychoanalytic therapy and
training in an online modality. First, this modality increases the availability of
psychoanalysis, psychotherapy, and training to potential patients and candi-
dates from remote areas. It also provides the opportunity for continuity for
those patients who otherwise are unable to come to an analyst’s office with
frequency due to long travel distances or to employment conditions.
Yet, Lynch had doubts that the standard analytic situation could be
carried out online since the analyst’s physical presence is held to be so
important.
In an effort to study if psychodynamic constructs (i.e., analysis of trans-
ference, resistances, defences, mental life, etc.) can be effectively con-
veyed online, Gordon and colleagues (2015) emailed 300 past and present
members of CAPA requesting that they respond to an online survey about
their experiences in teaching, supervising, and treating Chinese students
over VCON. The CAPA faculty is mainly English speaking Westerners,
mostly from the US. Of the 300 email requests, 176 took the online survey,
roughly a 59% response rate. The respondents were 65% female, 37%
were psychologists, 33% were social workers, and 22% were psychiatrists.
The teachers (n = 130) had an average of 18.35 years of experience (SD =
9.72), supervisors (n = 152) had an average of 18.63 years of experience
(SD = 10.21), and the therapists (n = 163) had an average of 23.84 years
of practicing psychoanalytic treatment (SD = 7.44). Seventy-nine per cent
(n = 175) stated that they have been using videoconferencing (VCON) for
three or more years for doing teaching, supervising, or treatment (M =
4.21, SD = 2.14). The results indicated that teaching, supervision, and
treatment were all rated in the range of “slightly less effective” than in-
person, with supervision rated significantly more effective than teaching
and treatment over VCON; when doing psychodynamic treatment over
VCON the issues of symptom reduction, exploring mental life, working on
transference, relational problems, resistance, privacy issues, countertrans-
ference, are all equally rated in the range of “slightly less effective” than
PSYCHODYNAMIC TREATMENT TO CHINESE STUDENTS OVER VCON 89
6-Gordon_OPUS_7_1.qxp copy.qxp 31/08/2016 13:49 Page 89
in-person treatment; the highest significantly rated indications for treat-
ment over VCON are: “To offer high quality treatment to underserved or
remote patients” and “When patient is house-bound or travel would be
impractical”, and the highest significantly rated contraindication for treat-
ment over VCON was: “Patient needs close observation due to crisis or
decompensation”.
Since the CAPA mailing list included members of CAPA who dropped
out, this added more variance to the sample in that it included dissatisfied
experts.
We wish to know more about this group of therapists who did not think
that online treatment was effective. There were 42 out of 102 therapists
(41%) who rated treatment effectiveness either “1” or “2” (1 = much less
effective, 2 = less effective than in-person, on a 7 point scale). We wanted
to investigate their characteristics and concerns about psychodynamic
treatment of Chinese students over VCON.
We hypothesised that gender, profession (psychiatrists, psychologists,
social workers, others), years doing therapy, and number of years using
VCON would all not be significantly related to how therapists rated the
effectiveness of treatment over VCON.
However, we predicted that low raters would feel that the psycho-
dynamic constructs (i.e., symptom reduction, exploring mental life, work-
ing with transference, working though relational problems, working with
resistances, privacy concerns, and countertransference issues) would not
translate effectively over the internet as compared to in-person treatment.
However, we also hypothesised that the low raters and higher raters (i.e.,
scores 3 = slightly less effective, 4 = no difference than in-person, etc.)
would agree that there was value in VCON treatment in that it offers high
quality treatment to underserved or remote patients, and it is valuable
when the patient is house-bound or travel would be impractical.
METHOD
We recruited our expert participants from the email list of 300 past and
present China American Psychoanalytic Alliance (CAPA) teachers, supervi-
sors and therapists. The email notices stated that participation is voluntary
and anonymous. They were given a link to the online survey on Survey
Monkey where their responses to the questions were automatically stored
and exported to SPSS for analysis. We stated in the survey: “Answer only
the questions as they apply to your work with CAPA. There may be issues
with differences in education, language, and cultural between your CAPA
students/supervisees/patients and your in-person American students/super-
visees/patients. For the sake of this research, please assume ‘all other things
being equal’ though this is not easy to do.”
90 ROBERT M. GORDON, JANE TUNE, and XIUBING WANG
6-Gordon_OPUS_7_1.qxp copy.qxp 31/08/2016 13:49 Page 90
The executive members of CAPA initially screened all the participants
for their expertise before they were allowed to offer their services to CAPA.
Additionally, the results indicating the many years of teaching, supervi-
sion, and treating, support our methodological assumption that this is a
survey of expert opinion.
For this current study, we specifically looked at only the responses of
CAPA therapists and only looked at the following questions regarding
demographic, profession, and experience:
1. gender
2. profession
3. years doing therapy
4. years using VCON
5. “How does videoconferencing compare to in-person treatment in
reducing symptoms?”
6. “How does videoconferencing compare to in-person treatment in
exploring the mental life of the patient?”
7. “How does videoconferencing compare to in-person treatment in
working on transference?”
8. “How does videoconferencing compare to in-person treatment in
working through relational problems?”
9. “How does videoconferencing compare to in-person treatment in
working with resistance?”
10. “How does videoconferencing compare to in-person treatment in
creating a sense of privacy?”
11. “How does videoconferencing compare to in-person treatment in
dealing with countertransference issues?” and the importance of these
treatment indications
12. “To offer high quality treatment to underserved or remote patients,”
13. “When patient is house-bound or travel would be impractical”
DEMOGRAPHICS
There were ninty-four CAPA therapists who completed the survey ques-
tions on treatment issues, of those fifty-five were female. Seventeen were
psychiatrists, forty-one were psychologists, twenty-seven were social
workers, and nine were other.
RESULTS
In order to avoid false positives due to the high number of comparisons
(13), we set the alpha level for significance at p< 0.001. We used ANOVA
with harmonic means to analyse the demographic variables, and with
PSYCHODYNAMIC TREATMENT TO CHINESE STUDENTS OVER VCON 91
6-Gordon_OPUS_7_1.qxp copy.qxp 31/08/2016 13:49 Page 91
each of the questions, we used Levene’s Test for Equality of Variances
(with equal variances not assumed) and Paired T tests for our specific
hypotheses. Also to control for the wide differences in variances we
assigned a “1” for low scores (1–2) and a “2” for high scores (3–7).
We hypothesised that profession, gender, years working with VCON,
and treatment online would not be factors in the ratings. As hypothesised:
using ANOVA with harmonic means, profession (psychiatrist N = 17,
psychologist N = 41, social worker N = 27, other N = 9) (p= 0.20) and
gender (p= 0.11) were not significantly different in how therapists rated
the effectiveness of treatment over VCON.
As hypothesised: the number of years doing therapy (p= 0.27) and
number of years using VCON (p= 0.42) were also both not significantly
different in how therapists rated the effectiveness of treatment over VCON.
As hypothesised: low effectiveness raters and higher effectiveness
raters significantly differed on all the questions regarding psychodynamic
treatment over VCON: symptom reduction, exploring mental life, working
with transference, working though relational problems, working with resis-
tances, privacy concerns, and countertransference (p< 0.001, 2-tailed, for
all these comparisons).
Low effectiveness raters differed from the higher effectiveness raters in
all the questions on psychodynamic psychotherapy constructs (in order of
degree of mean differences) (1 = not effective, 2 = effective):
“How does videoconferencing compare to in-person treatment in explor-
ing the mental life of the patient?” mean difference = 0.86 (low n = 29, M
= 1.03, SD = 0.19; high n = 57, M = 1.90, SD = 0.31, p< 0.0001)
“How does videoconferencing compare to in-person treatment in reducing
symptoms?” mean difference = 0.79 (low n = 31, M = 1.10, SD = 0.30;
high n = 52, M = 1.89, SD = 0.32, p< 0.0001)
“How does videoconferencing compare to in-person treatment in dealing
with countertransference issues?” mean difference = 0.72 (low n = 24, M
= 1.08, SD = 0.28; high n = 62, M = 1.80, SD = 0.40, p< 0.0001)
“How does videoconferencing compare to in-person treatment in working
through relational problems?” mean difference = 0.67 (low n = 30, M =
1.17, SD = 0.38; high n = 56, M = 1.84, SD = 0.37, p< 0.0001)
“How does videoconferencing compare to in-person treatment in working
with resistance?” mean difference = 0.66 (low n = 36, M = 1.22, SD =
0.42; high n = 50, M = 1.90, SD = 0.33, p< 0.0001)
“How does videoconferencing compare to in-person treatment in creating
a sense of privacy?” mean difference = 0.64 (low n = 30, M = 1.20, SD =
0.41; high n = 55, M = 1.84, SD = 0.37, p< 0.0001)
92 ROBERT M. GORDON, JANE TUNE, and XIUBING WANG
6-Gordon_OPUS_7_1.qxp copy.qxp 31/08/2016 13:49 Page 92
“How does videoconferencing compare to in-person treatment in working
on transference?” mean difference = 0.61 (low n = 34, M = 1.24, SD =
0.43; high n = 52, M = 1.85, SD = 0.36, p< 0.0001)
As hypothesised low raters and high raters did not significantly differ in
the indications for VCON:
“To offer high quality treatment to underserved or remote patients,” mean
difference = 0.01 (low n = 5, M = 1.60, SD = 0.55; high n = 79, M = 1.61,
SD = 0.49, p= 0.97)
“When patient is house-bound or travel would be impractical”, mean dif-
ference = 0.35 (low n = 7, M = 1.29, SD = 0.49; high n = 57, M = 1.64,
SD = 0.49, p= 0.11) (See Table 1).
Table 1. Low effectiveness raters vs. high effectiveness raters on the use of
therapy over VCON
Comparing VCON with Mean difference between high and low raters
in-person Tx
Exploring the mental life low n = 29, M = 1.03, SD = 0.19
of the patient high n = 57, M = 1.90, SD = 0.31, p< 0.0001
Reducing symptoms low n = 31, M = 1.10, SD = 0.30
high n = 52, M = 1.89, SD = 0.32, p< 0.0001
Dealing with low n = 24, M = 1.08, SD = 0.28
countertransference issues high n = 62, M = 1.80, SD = 0.40, p< 0.0001
Working through relational low n = 30, M = 1.17, SD = 0.38
problems high n = 56, M = 1.84, SD = 0.37, p< 0.0001
Working with resistance low n = 36, M = 1.22, SD = 0.42
high n = 50, M = 1.90, SD = 0.33, p< 0.0001
Sense of privacy low n = 30, M = 1.20, SD = 0.41
high n = 55, M = 1.84, SD = 0.37, p< 0.0001
Working on transference low n = 34, M = 1.24, SD = 0.43
high n = 52, M = 1.85, SD = 0.36, p< 0.0001
Offer treatment to underserved low n = 5, M = 1.60, SD = 0.55
or remote patients high n = 79, M = 1.61, SD = 0.49, p< = 0.97
Patient is house-bound or travel low n = 7, M = 1.29, SD = 0.49
would be impractical high n = 57, M = 1.64, SD = 0.49, p= 0.11
Most the therapists who use VCON for treating patients in China rate it high
on the psychodynamic variables. Low raters while differing with high raters
on the effectiveness of psychodynamic therapy over VCON as compared to
in-person, do not differ with high raters on the value of psychodynamic
therapy over VCON for treating underserved or remote patients, and when
the patient is house-bound or when travel would be impractical.
1 = not effective, 2 = effective.
PSYCHODYNAMIC TREATMENT TO CHINESE STUDENTS OVER VCON 93
6-Gordon_OPUS_7_1.qxp copy.qxp 31/08/2016 13:49 Page 93
DISCUSSION
Gordon and colleagues (2015) found that 60% of CAPA therapists over-
all considered delivering psychodynamic psychotherapy with VCON
favourably. However, we wanted to explore the characteristics and con-
cerns of those few therapists who were most critical of psychodynamic
treatment over VCON. These results suggest that therapists who rate
psychodynamic psychotherapy over VCON low (i.e., “Much less effective
than in-person” and “Less effective than in-person”) than higher raters (i.e.,
“Slightly less effective,” “No difference,” “slightly more effective,” etc.)
believe that the psychodynamic constructions are not effectively translated
over VCON as compared to in-person treatment. The issues of symptom
reduction, exploring mental life, working with transference, working
though relational problems, working with resistances, privacy concerns,
and countertransference issues were all considered negatively affected by
online work. Low raters felt that exploring the mental life of the patient was
most affected by VCON and working on transference was least affected by
VCON.
Nevertheless, low raters of effectiveness and higher raters of effective-
ness agree on that treatment over VCON is valuable since it offers high
quality treatment to underserved or remote patients, and it is valuable
when the patient is house-bound or travel would be impractical.
Perhaps these low effectiveness raters were comparing VCON psycho-
dynamic treatment to more familiar psychoanalytic conditions rather than
considering new ways of extending psychodynamic thought and services.
Many of the CAPA therapists expressed the opinion that the problems
posed by using VCON were grist for the mill and interpretable. As one
respondent of the survey stated in a comment box, “Most of the problems
with teletherapy can be dealt with by interpretation and working through.”
Profession (i.e., psychiatrist, psychologist, social worker, other), gender,
years working with VCON, and years doing treatment were not factors in
the ratings.
The limitations of this study are that it is a survey of the opinions of
experts, and not a randomly controlled outcome study. We recommend
more empirical research in this area using a variety of methodologies. The
condition of the differences in culture and language were held constant:
that is both high and low rates were mainly English-speaking Westerners
treating CAPA English-speaking patients in China. Further research is
needed to see how much culture and language are factors in using VCON.
Gordon and Lan (in press) looked at this question with a sample of Chinese
patients. Our findings suggest that the Chinese patients feel that the thera-
pists’ qualities (warmth, wisdom, empathy, and skilfulness) are more
important than both issues of cultural difference and whether the treatment
was over the internet or in-person.
94 ROBERT M. GORDON, JANE TUNE, and XIUBING WANG
6-Gordon_OPUS_7_1.qxp copy.qxp 31/08/2016 13:49 Page 94
NOTE
1. This research was approved by the IRB of the Washington Center of
Psychoanalysis.
REFERENCES
Backhaus, A., Agha, Z., Maglione, M. L., Repp, A., Ross, B., Zuest, D., & Thorp,
S. R. (2012). Videoconferencing psychotherapy: a systematic review.
Psychological Services, 9(2): 111–131.
Bayles, M. (2012). Is physical proximity essential to the psychoanalytic process?
An exploration through the lens of Skype? Psychoanalytic Dialogues, 22(5):
569–585.
Berle, D., Starcevic, V., Milicevic, D., Hannan, A., Dale, E., Brakoulias, V., &
Viswasam, K. (2015). Do patients prefer face-to-face or Internet-based
therapy? Psychotherapy and Psychosomatics, 84(1): 61–62.
Caparrotta, L. (2013). Digital technology is here to stay and the psychoanalytic
community should grapple with it. Psychoanalytic Psychotherapy, 27(4):
296–305. doi: 10.1080/02668734.2013.846272
Churcher, J. (2012). On: Skype and privacy: comment. The International Journal
of Psychoanalysis, 93(4): 1035–1037. doi: 10.1111/j.1745-8315.2012.
00610.x
Dettbarn, I. (2013). “. . . When the distinction between imagination and reality is
effaced . . .” (Freud): Skype, the secret sharer, and psychoanalysis. Psyche:
Zeitschriftfür Psychoanalyse und ihre Anwendungen, 67(7): 649–664.
Fishkin, R., Fishkin, L., Leli, U., Katz, B., & Snyder, E. (2011). Psychodynamic
treatment, training, and supervision using internet-based technologies. Journal
of the American Academy of Psychoanalysis & Dynamic Psychiatry, 39(1):
155-168. doi: 10.1521/jaap.2011.39.1.155
Gordon, R. M., & Lan, J. (In press). Assessing Distance Analytic Training: How
Well Does It Produce Psychoanalytic Therapists? (manuscript submitted for
publication).
Gordon, R. M., Wang, X., & Tune, J. (2015). Comparing psychodynamic teach-
ing, supervision and psychotherapy over video-conferencing technology with
Chinese students. Psychodynamic Psychiatry, 43(4): 585–599.
Johansson, R., Nyblom, A., Carlbring, P., Cuijpers, P., & Andersson, G. (2013).
Choosing between Internet-based psychodynamic versus cognitive behavioral
therapy for depression: a pilot preference study. BMC Psychiatry, 13(1): 1.
King, V. L., Brooner, R. K., Peirce, J. M., Kolodner, K., & Kidorf, M. S. (2014).
A randomized trial of Web-based videoconferencing for substance abuse
counseling. Journal of Substance Abuse Treatment, 46(1): 36–42. doi:
10.1016/j.jsat.2013.08.009
Lemma, A., & Caparrotta, L. (Eds.) (2013). Psychoanalysis in the Technoculture
Era. London: Routledge.
Lynch, A. A. (2015). Cyberspace and psychoanalysis. Working electronically:
a special issue of round robin newsletter of Section 1. Psychologist-
Psychoanalyst Practitioners, 30(2): 10–12.
PSYCHODYNAMIC TREATMENT TO CHINESE STUDENTS OVER VCON 95
6-Gordon_OPUS_7_1.qxp copy.qxp 31/08/2016 13:49 Page 95
Paolo, M. (2013). Psychoanalysis on the Internet: a discussion of its theoretical
implications for both online and offline therapeutic technique. Psychoanalytic
Psychology, 30(2): 281–299.
Scharff, D. E. (2015). Psychoanalytic teaching by video link and telephone.
Journal of the American Psychoanalytic Association, 63(3): 443–468. doi.
0003065115591274
Scharff, J. S. (2013a). “On: Skype and privacy: comment”: reply. [Comment/
Reply] International Journal of Psychoanalysis, 93(4): 1037–1039. doi:
10.1111/j.1745-8315.2012.00609.x
Scharff, J. S. (Ed.) (2013b). Psychoanalysis Online: Mental Health,Teletherapy
and Training. London: Karnac.
Scharff, J. S. (Ed.) (2015). Psychoanalysis Online II. London: Karnac.
Sucala, M., Schnur, J. B., Constantino, M. J., Miller, S. J., Brackman, E. H., &
Montgomery, G. H. (2012). The therapeutic relationship in e-therapy for
mental health: a systematic review. Journal of Medical Internet Research,
14(4): 175–187. doi: 10.2196/jmir.2084
96 ROBERT M. GORDON, JANE TUNE, and XIUBING WANG
6-Gordon_OPUS_7_1.qxp copy.qxp 31/08/2016 13:49 Page 96
... Ten studies investigated a variety of aspects related to the use of telepsychotherapy in depression (Catarino et al., 2018;Egede et al., 2015Egede et al., , 2016Ekberg, Barnes, Kessler, Malpass, & Shaw, 2016;Ekberg et al., 2015;Etzelmueller et al., 2018), anxiety (Catarino et al., 2018;Théberge-Lapointe, Marchand, Langlois, Gosselin, & Watts, 2015), post-traumatic stress disorder -PTSD (Wierwille, Pukay-Martin, Chard, & Klump, 2016), panic attacks (Cipolletta, Frassoni, & Faccio, 2018) and bulimia nervosa (Zerwas et al., 2016). Eight works surveyed both the attitudes towards and the use of telepsychotherapy in the general public (Apolinário-Hagen, Vehreschild, & Alkoudmani, 2017;Hantsoo, Podcasy, Sammel, Epperson, & Kim, 2017), among psychotherapists (Gilmore & Ward-Ciesielski, 2019;Gordon, Tune, & Wang, 2016;Gordon, Wang, & Tune, 2015;Pierce, Perrin, & McDonald, 2019 and comparing health-care professionals and nonprofessionals (Schulze et al., 2019). ...
... Cognitive/behavioral approaches were the most represented, including individual (Catarino et al., 2018;Egede et al., 2015Egede et al., , 2016Etzelmueller et al., 2018;Théberge-Lapointe et al., 2015) and group (Zerwas et al., 2016) cognitive behavioral therapy -CBT, the behavioral activation therapy for depression (Ekberg et al., 2016), the brief strategic approach (Cipolletta et al., 2018) and the cognitive processing and prolonged exposure therapy (Wierwille et al., 2016). One of the survey-studies focused on the psychodynamic approach (Gordon et al., 2016(Gordon et al., , 2015; the others addressed attitudes towards telepsychotherapy in general (Apolinário-Hagen et al., 2017;Gilmore & Ward-Ciesielski, 2019;Hantsoo et al., 2017;Pierce et al., 2020;Schulze et al., 2019). ...
... Survey-studies investigating attitudes towards telepsychotherapy reported that psychotherapists generally perceived videoconferencing treatments as possibly less effective than face-toface therapies (Gordon et al., 2016(Gordon et al., , 2015Schulze et al., 2019). Psychotherapists dealing with suicidal patients expressed specific worries about the impossibility of taking advantage of nonverbal and emotional cues during the patient's assessment and to exert a direct control over the patient if hospitalization is needed (Gilmore & Ward-Ciesielski, 2019 (Pierce et al., 2020). ...
... Ten studies investigated a variety of aspects related to the use of telepsychotherapy in depression (Catarino et al., 2018;Egede et al., 2015Egede et al., , 2016Ekberg, Barnes, Kessler, Malpass, & Shaw, 2016;Ekberg et al., 2015;Etzelmueller et al., 2018), anxiety (Catarino et al., 2018;Théberge-Lapointe, Marchand, Langlois, Gosselin, & Watts, 2015), post-traumatic stress disorder -PTSD (Wierwille, Pukay-Martin, Chard, & Klump, 2016), panic attacks (Cipolletta, Frassoni, & Faccio, 2018) and bulimia nervosa (Zerwas et al., 2016). Eight works surveyed both the attitudes towards and the use of telepsychotherapy in the general public (Apolinário-Hagen, Vehreschild, & Alkoudmani, 2017;Hantsoo, Podcasy, Sammel, Epperson, & Kim, 2017), among psychotherapists (Gilmore & Ward-Ciesielski, 2019;Gordon, Tune, & Wang, 2016;Gordon, Wang, & Tune, 2015;Pierce, Perrin, & McDonald, 2019 and comparing health-care professionals and nonprofessionals (Schulze et al., 2019). ...
... Cognitive/behavioral approaches were the most represented, including individual (Catarino et al., 2018;Egede et al., 2015Egede et al., , 2016Etzelmueller et al., 2018;Théberge-Lapointe et al., 2015) and group (Zerwas et al., 2016) cognitive behavioral therapy -CBT, the behavioral activation therapy for depression (Ekberg et al., 2016), the brief strategic approach (Cipolletta et al., 2018) and the cognitive processing and prolonged exposure therapy (Wierwille et al., 2016). One of the survey-studies focused on the psychodynamic approach (Gordon et al., 2016(Gordon et al., , 2015; the others addressed attitudes towards telepsychotherapy in general (Apolinário-Hagen et al., 2017;Gilmore & Ward-Ciesielski, 2019;Hantsoo et al., 2017;Pierce et al., 2020;Schulze et al., 2019). ...
... Survey-studies investigating attitudes towards telepsychotherapy reported that psychotherapists generally perceived videoconferencing treatments as possibly less effective than face-toface therapies (Gordon et al., 2016(Gordon et al., , 2015Schulze et al., 2019). Psychotherapists dealing with suicidal patients expressed specific worries about the impossibility of taking advantage of nonverbal and emotional cues during the patient's assessment and to exert a direct control over the patient if hospitalization is needed (Gilmore & Ward-Ciesielski, 2019 (Pierce et al., 2020). ...
Article
COVID-19 outbreak imposes the adoption of extraordinary containment measures, including the strict necessity to limit interpersonal contact. Face-to-face psychotherapy collides with this requirement and, above all, it might endanger both therapists and patients’ safety. Telepsychotherapy might come to the aid, ensuring therapeutic continuity and the possibility to reach people who might benefit of extra psychological support. Infectious outbreaks have been indeed associated with major psychopathological outcomes. The aim of the present work is to review the most recent experimental evidence about telepsychotherapy, focusing on its effectiveness, possible determinants of efficacy and therapists/patients’ attitudes, to rapidly inform psychotherapists. Out of the 857 records found, 18 studies have been included in the review. Our results show that, despite therapists and public’s skepticism, telepsychotherapy is a trustworthy alternative to be adopted, which can be used efficaciously to treat common mental-health disorders such as anxiety, depression and post-traumatic distress. As well as in the traditional setting, a higher number of sessions and the proper management of patients’ expectations seem to be associated with better outcomes. On the contrary, low familiarity with web-based means of communication and technical issues might reduce specifically the effectiveness of telepsychotherapy.
... On the other hand, an interview study of cognitive behavioural therapists (Bengtsson et al., 2015) showed that they viewed the traditional face-to-face setting as a stronger experience than Internetbased CBT (more focused, easier to adapt to the client, more reinforcing, more demanding, and bringing more focus to the therapist) and as more easily promoting a working alliance. A study of 94 psychodynamic therapists treating Chinese students over videoconferencing (Gordon et al., 2016) showed that the therapists regarded this treatment modality as a valuable way of offering therapy to underserved and remote patients. Therapists rating the effectiveness of videoconferencing as low and those rating it as high differed regarding specific psychodynamic variables, such as exploring mental life, working through relational problems, working with resistance transference and countertransference, and privacy concerns. ...
... The depth of the therapeutic work, physical proximity in the same room, mental presence, and treatment effectiveness are not necessarily connected. One conclusion from a study of psychodynamic therapists treating Chinese students over the Internet (Gordon et al., 2016) was that the patients seemed to value the therapist's warmth, wisdom, empathy, and skilfulness as more important than in-person contact. Could the shared physical space be more important to therapists than to patients? ...
Article
Full-text available
The COVID-19 pandemic crippled many parts of society as it spread throughout the world beginning in early 2020. Overnight, whole societies were forced to change their way of life, because of social distancing and lockdowns. For therapists, the pandemic meant that in-person sessions were no longer possible and many switched to different forms of synchronous remote communication by telephone, online audio or video link. The aim of this study was to explore psychodynamic therapists’ experiences over time of forced transitions to telepsychotherapy. Five therapists were interviewed at the beginning of the pandemic and at a one-year follow-up. The data were analysed by applying thematic analysis with a phenomenological approach. Initially, the therapists struggled with technical and safety issues. The loss of the therapy room and of access to non-verbal nuances contributed to impaired contact with the patients and more superficial conversations. The therapists experienced that the very nature of psychodynamic psychotherapy was affected, even if telepsychotherapy could give some new opportunities. One year later many of the difficulties remained, but the therapists developed better coping strategies and were back to the therapy focus. One implication of this study is that telepsychotherapy needs to be integrated into psychotherapy training and supervision.
... The therapists felt that with distance treatment, the issues of symptom reduction, exploring mental life, working with transference, working though relational problems, working with resistances, privacy concerns, and countertransference issues were all rated in the range of "slightly less effective" than in-office treatment (All the ratings went from 1 = much less effective, 2 = less effective, 3 = slightly less effective, 4 = no difference (from in-person treatment), 5 = slightly more effective, 6 = more effective, and 7 = much more effective.) Gordon, Tune & Wang (2016) found that the mean ratings of "slightly less effective" in their previous study was actually a combination of two very different groups: 40% felt distance treatment was clearly "less effective" and 60% felt that it was "similar to in-office work." Nevertheless, low-raters and higher-raters of effectiveness both agree that treatment over VCON is valuable since it offers quality treatment to under-served or remote patients, and it is valuable when the patient is house-bound or when travel would be impractical. ...
... Previous research on distance treatment usually treated psychoanalytic practitioners as an unimodal group. However, Gordon, Tune & Wang (2016) found that there is a very distinct group of practitioners who are strongly opposed to distance psychoanalytic treatment. We believe that averaged ratings of opinions do not always give a clear picture of psychoanalytic practitioners' attitudes toward distance treatment. ...
Article
Full-text available
We conducted an international survey to better understand both the negative and positive reactions of distance treatment during the pandemic. We received 1,490 survey responses from practitioners from 56 regions and countries who remotely treated patients psychoanalytically during the beginning months of the Covid-19 pandemic. Eighty-nine percent of the practitioners agreed or strongly agreed that distance treatment is valuable when the patient is house-bound or when travel would be difficult or impractical. They also expected to treat about 47% of their patients via teletherapy in the future. A minority group (17%) with mainly negative opinions do not feel that distance analytic treatment is effective with exploring mental life. Those with mainly negative opinions had more difficulty with the technology, had little value for teletherapy even for the patient who is homebound or when travel would be impractical, and considered bodily presence as very important to outcome. The majority of respondents who have mainly positive opinions feel that they can work effectively with transference, resistance and relational problems in distance analytic treatment.
... In this article, I will summarize the research on distance training and treatment with the China American Psychoanalytic Alliance (CAPA) students. Researchers who wish to know more of the literature review, methods and statistics can access the original papers (Gordon & Lan, 2017;Gordon, Tune, & Wang, 2016;Gordon, Wang, & Tune, 2015). ...
... In this next study, we asked, "What are the characteristics and concerns of high and low raters of psychodynamic treatment to Chinese students over VCON?" (Gordon, Tune, & Wang, 2016). We wanted to explore why some therapists were concerned about the use of VCON and rated it much less effective than local work, while others rated it just as effective. ...
Article
Full-text available
I summarize several studies on the effectiveness of distance training and treatment¹¹ I will use the term “distance treatment,” but this is interchangeable with other terms as such as “Internet mediated therapy” “remote treatment,” telepsychotherapy,” “Video-conferencing mediated treatment.”View all notes with Chinese mental health professionals. We found that experts on the average felt that teaching, supervising and treating over video-conferencing (VCON) were only “slightly less effective” than local work. The highest significantly rated indications for treatment over VCON are: “To offer high-quality treatment to underserved or remote patients” and “When patient is house-bound or travel would be impractical.” The highest significantly rated contraindication for treatment over VCON is “Patient needs close observation due to crisis or decompensation.” The next logical step was to assess the opinions of CAPA graduates about the effectiveness of their distance psychoanalytic training and treatment. We found that the more the graduates used a psychoanalytic formulation was highly correlated with the number of years in distance education and the more days a week in their own therapy. Graduates highly rated the effectiveness of their own psychoanalytic therapy over VCON. The CAPA graduates thought that the therapist variables (warmth, wisdom, empathy, and skillfulness) were far more important in the effectiveness of their treatment than whether the treatment was local or with VCON, or the cultural differences with their therapist. The graduates’ ratings of how they are currently practicing psychoanalytic psychotherapy were highly correlated with how their own therapists practiced psychoanalytic treatment, as measured by the Comparative Psychotherapy Process Scale (CPPS) items. Dr. Maranda Sze’s preliminary findings from a survey of 163 CAPA students found that they increased from practicing psychodynamic psychotherapy from 55% pre-CAPA to 78% currently, with increased private practice hours, and increase in fees charged. There was also significant increased time in their own psychoanalytic treatment. Overall, these studies show the success of creating a new generation of psychoanalytic therapists in China.
... In a follow up study (Gordon et al., 2016), ninety-four CAPA therapists were surveyed in order to assess what differentiated low raters from higher raters of treatment effectiveness over VCON. As hypothesised, gender, profession, number of years practising therapy, and number of years using VCON were all not significantly related to how therapists rated the effectiveness of treatment over VCON. ...
Article
Full-text available
We present three recent research projects from China on distance psychoanalytic training and treatment. The first study explored how the internet could influence the process of psychoanalysis in three ways. First, choosing to accept online psychoanalysis is itself meaningful to the patients. Second, the internet connection itself can also be an organic component of the psychoanalysis. Third, the patients could see the real-time images of themselves during the online psychoanalysis, which could influence the analytic process. The second study found that psychoanalysis provides an important support to improve the process of individualisation among Chinese people. The results indicate that Chinese people have been through many traumatic events in the past century, such as civil wars, colonisation, and the Cultural Revolution. Through therapy, these hidden pains are expressed, understood, and healed. Psychoanalysis brings about a new dialectic relationship model: on the one hand, it is a very intimate relationship, you can talk and share everything in your life with a specific person; on the other hand, it is quite different from the traditional Chinese relationship model. They see psychoanalysis as a bridge, enabling the participants to achieve their connection with Chinese culture by using Chinese literature, art, religion, philosophy, to find their own path of individualisation. The third study surveyed 163 graduates of a distance psychoanalytic programme and found that the graduates developed a strong identification with the psychoanalytic field, with private practice clinical hours increased and fees increased. Looking forward to the future, 92% of the respondents plan to be supervisors, 78% to be analysts, 73% to be teachers, 46% to be authors, and 36% to be speakers.
... Conversely, despite the evidence for its effectiveness, negative attitudes about telepsychotherapy are prevalent (see also Varker et al., 2018). Survey studies have reported that approximately half of all respondent psychotherapists perceive telepsychotherapy as less effective than face-to-face psychotherapy (Gordon et al., 2015(Gordon et al., , 2016Schulze et al., 2018). Indeed, there are ethical arguments against the seamless implementation of online therapy, including (1) privacy, confidentiality, and security issues, (2) therapist competence and need for special training, (3) communication issues specific to technology, (4) research gaps, and (5) emergency issues (Stoll et al., 2020). ...
Article
Full-text available
Aims: Italy was one of the first countries to be significantly affected by the coronavirus disease 2019 (COVID-19) pandemic, determining a unique scenario for Italian psychotherapists to consider changing the modality in which they deliver treatment. The present study aimed at studying which factors related to psychotherapists and their clinical practice had a major role in predicting two main outcomes: (1) the rate of interrupted treatments during lockdown and (2) psychotherapists’ satisfaction with the telepsychotherapy modality. Methods: An online survey was administered to licensed psychotherapists (n = 306), who worked mainly as private practitioners, between April 5 and May 10, 2020 (i.e., the peak of the pandemic in Italy). Results: Psychotherapists reported that 42.1% (SD = 28.9) of their treatments had been interrupted, suggesting that Italy faced an important undersupply of psychotherapy during the lockdown. Using the Akaike information criterion (AIC) model selection, we identified three predictors of the rate of interrupted treatments: (1) psychotherapists’ lack of experience with telepsychotherapy prior to the lockdown, (2) their theoretical orientation (with cognitive behavioral psychotherapists reporting a higher rate of interrupted treatments), and (3) patients’ lack of privacy at home, as reported to the psychotherapists. Furthermore, we found four predictors of psychotherapists’ satisfaction with the telepsychotherapy modality: (1) the rate of interrupted treatments, (2) psychotherapists’ previous experience with telepsychotherapy, (3) their beliefs about the compatibility of telepsychotherapy with their theoretical orientation, and (4) their use of a video-conferencing modality, rather than telephone. Conclusion: The following recommendations can help policy makers, professional associations, and practitioners in promoting the continuity of psychotherapy treatments during the COVID-19 outbreak and in future emergencies: (i) disseminating training programs for practitioners on telepsychotherapy, (ii) supporting patients to pragmatically access a private space at home, (iii) encouraging practitioners to use video-conferencing (instead of telephone) to deliver remote therapy, and (iv) increasing the acceptance of telepsychotherapy among both clinicians and the general public.
Article
Using extensive quotation, the author reviews the introduction and current state of psychoanalysis and psychoanalytic psychotherapy in China from the vantage point of recent publications in English. Psychoanalysis was briefly introduced to China before the Communist era, then forbidden, and has experienced an accelerated reintroduction since the late 1980s. The author briefly summarizes the cultural and historical background of China relevant to the introduction of psychoanalysis, the traumatic history of China, and the deep structure of thought and philosophical differences from Western culture that challenge a simple imposition of psychoanalytic ideas and practice, and some psychological effects of rapid cultural change throughout China. Training programs in China, the general enthusiasm for analysis among the Chinese, and a number of notable contributions by Western and Chinese authors are discussed. Also surveyed are the use of distance technology for training and treatment, the personal experience of Chinese senior and junior colleagues, and ongoing challenges to the continuing growth of psychoanalysis and analytic psychotherapy in China.
Article
Full-text available
How effective is psychoanalytic/psychodynamic distance training over the Internet? To assess this, we surveyed graduates of the 2 year and 4 year programs of the China America Psychoanalytic Alliance (CAPA). The main results of the 90 graduates’ surveys showed that 77% of their work involves a psychoanalytic formulation of their cases as compared to other theoretical orientations. The degree to which graduates used a psychoanalytic formulation of their cases was best predicted by the number of years in training and the more days a week in their own treatment. Graduates highly rated the effectiveness of their own psychoanalytic therapy over videoconferencing (VCON). Graduates’ ratings of treatment with their patients over VCON positively correlated with years of psychoanalytic education, number of days a week in own treatment, years doing psychoanalytic treatment, and degree working with a psychoanalytic orientation. Graduates thought that therapist variables (skillfulness, warmth, empathy, and wisdom) were much more important in the effectiveness of their treatment than whether the treatment was in-person or with VCON, or the presence of cultural differences with their therapist. The graduates’ ratings of how they are practicing psychoanalytic treatment were highly correlated with how their own therapists practiced psychoanalytic psychotherapy, as measured by the psychodynamic/interpersonal process items on the Comparative Psychotherapy Process Scale.
Article
Full-text available
How do experts compare teaching, supervision and treatment from a psychodynamic perceptive over the Internet with in-person work? Our methodology was based on the expert opinions of 176 teachers, supervisors and therapists in the China American Psychoanalytic Alliance (CAPA) who use video-conferencing (VCON) with Chinese students. The results from our on-line survey indicate: 1.The longer teachers teach, the more effective they rate teaching over VCON; 2. Teaching, supervision and treatment were all rated in the range of “slightly less effective" than in-person, with supervision rated significantly more effective than teaching and treatment over VCON; 3. When doing psychodynamic treatment over VCON the issues of symptom reduction, exploring mental life, working on transference, relational problems, resistance, privacy issues, countertransference, are all equally rated in the range of "slightly less effective" than in-person treatment; 4. The highest significantly rated indications for treatment over VCON are: "To offer high quality treatment to underserved or remote patients" and "When patient is house-bound or travel would be impractical;" and 5. The highest significantly rated contraindication for treatment over VCON is: "Patient needs close observation due to crisis or decompensation." Overall, this survey suggests that VCON teaching, supervision and treatment from a psychodynamic perceptive is a worthwhile option when considering its unique contribution to extending services where needed.
Article
Full-text available
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 psychoanalytic 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.
Article
Full-text available
Major depression is a world-wide problem that can be treated with various forms of psychotherapy. There is strong research support for treating major depression using cognitive behavior therapy delivered in the format of guided self-help via the Internet (ICBT). Recent research also suggests that psychodynamic psychotherapy can be delivered as guided self-help via the Internet (IPDT) and that it seem to be as effective as ICBT for mild to moderate depression. However, no head-to-head comparison between the two treatments exists. In the field of Internet interventions it is largely unexplored if treatment preference affects outcome and adherence. Participants were allocated to IPDT or ICBT based on their stated preference. More than half of the participants preferred ICBT (N = 30) over IPDT (N = 14). Differences in efficacy between treatments were explored. Correlations between strength of preference and treatment outcome, adherence to treatment and completion of the whole treatment program were explored. Data were collected before and after treatment, as well as in a 7-month follow-up. During the treatment period, both programs performed equally well in reducing symptoms. More participants who received IPDT completed the entire program. At follow-up, mixed-effects models showed that participants who chose ICBT improved more in terms of quality of life. The ICBT group also had a significant increase in participants who recovered from their depression from post-treatment to follow-up. Exploratory analyses indicated that strength of preference was correlated with adherence to treatment and completion of the whole program, and long-term outcome for the ICBT group. Few differences were found during the acute treatment phase, but the long-term effects are in favor of ICBT. Strength of preference for treatment seems to have a predictive value. Further research comparing the efficacy of ICBT and IPDT, and the effects of preference matching and strength of preference, is warranted.Trial registration: This trial is a continuation of the study registered as NCT01324050 at Clinicaltrials.gov.
Article
Full-text available
The focus of this paper is to raise questions about the essential elements of the analytic process and whether they can be met when we move to technological modalities like Skype or the telephone. To the extent that therapeutic action is grounded in implicit, procedural, nonverbal communication the entire body is implicated in the analytic dialogue. To varying degrees technological modalities limit access to the information communicated via the body. Even when the Skype web-cam offers visual access to our patients, I argue that the quality and impact of information communicated between the various sense modalities, both intrapersonally and interpersonally, will be dampened, thereby compromising the quality of information exchanged in the nonverbal domain. Philosopher Shaun Gallagher (2005) argued that due to the cross-modal linkage between the visual and proprioceptive senses, when we see someone we “see” them with our whole brain, including the extended nervous system. That is, we use our whole body “to see” the person with whom we are in dialogue. As psychoanalysis increasingly engages technology we need to consider the repercussions of how limitations to information communicated by the body in the nonverbal domain influence the analytic dialogue.
Article
On the basis of her own experiences, the author inquires into the implications of conducting psychoanalytic interviews with the aid of Skype (video telephones). What feelings, fantasies, and thoughts do analyst and client entertain when they hear each other's disembodied voices from a loudspeaker and observe the video transmission on a screen? Does the absence of spatial and physical proximity interfere with the development of trust necessary for successful therapy? Can this new factor in the analytic process lead to a dangerous denial of the reality of separation and mourning? Is Skype a protection against the real dangers attendant upon physical presence (violence, aggression, sexual seduction)? Are transference, resistance, and regression suddenly relegated to the realm of magic? In short, is Skype an uncanny secret sharer in the therapeutic process?
Article
In this era of global connectedness, there is great interest in using distance video platforms such as Skype and VSee, as well as the telephone, for conducting psychoanalysis and psychotherapy across geographic distance. Little, however, has been written about the use of technology for psychoanalytic education. The International Psychotherapy Institute has extensive experience in the use of videoconference and telephone technology in the teaching of psychoanalysis and psychoanalytic psychotherapy, including didactic teaching, infant observation, and individual and group supervision, with individuals and groups across the United States and overseas. Use of this technology for tele-education has facilitated the spread of psychoanalytic ideas, recruitment of psychoanalytic and psychotherapeutic trainees, and ongoing training for members living at great distances from one another and from the institute. This work is in many ways similar to ordinary psychoanalytic teaching and supervision, and yet presents significant differences in technique, opportunity, and group dynamics. Further implementation and study of this methodology can greatly aid in the dissemination of psychoanalysis in the digital age. © 2015 by the American Psychoanalytic Association.
Article
Digital technologies have revolutionised our lives and are also gradually affecting the way psychoanalytic psychotherapists and their patients interact. The author claims that these changes need to be embraced responsibly and with an open mind by the profession and illustrates some of his own experiences with clinical material.
Article
Web-based videoconferencing can improve access to substance abuse treatment by allowing patients to receive counseling services in their homes. This randomized clinical trial evaluates the feasibility and acceptability of Web-based videoconferencing in community opioid treatment program (OTP) participants. Participants that reported computer and Internet access (n=85) were randomly assigned to receive 12weeks of weekly individual counseling in-person or via eGetgoing, a Web-based videoconferencing platform. Fifty-nine of these participants completed the study (eGetgoing=24; in-person=35), with most study withdrawal occurring among eGetgoing participants. Participants exposed to the study conditions had similar rates of counseling attendance and drug-positive urinalysis results, and reported similar and strong ratings of treatment satisfaction and therapeutic alliance. These results support the feasibility and acceptability of Web-based counseling as a good method to extend access to individual substance abuse counseling when compared to in-person counseling for patients that are able to maintain a computer and Internet connection for reliable communication.