Lena Theodorou Ehrlich’s research while affiliated with Michigan Psychoanalytic Institute and other places

Given that practicing teleanalytically is relatively new and more widespread than ever, questions about how to practice and teach it effectively have increased and are more pressing than ever. To contribute answers to these questions, this paper addresses long-standing and persisting negative views of teleanalysis as an inherently muted, remote, and pale experience with reduced therapeutic effectiveness. I propose that this view of teleanalysis as inherently inferior to in-office analysis limits or even precludes its therapeutic usefulness because it allows analysts to avoid making analytic use of the disturbing feelings hiding within the experience of practicing teleanalysis. Through case examples, I suggest that when analysts do not take our negative views of teleanalysis at face value but instead consider them as symbolic expressions of our and our patients’ anxieties, we can improve our understanding of our analytic functioning within the tele-setting and enhance our capacity to think and engage analytically effectively in any setting. I maintain that these considerations have important implications, not only for how experienced analysts practice, but also for how we treat and teach future analysts.

How do we maintain our psychoanalytic footing during a frightening crisis that affects us all? How do we work effectively within a medium that most of us have not been trained for, might have little prior experience with, and that some worry is not effective? Even more daunting, how do we manage these two monumental challenges simultaneously? This paper will consider these predicaments and explore the conditions that promote useful psychoanalytic work while meeting on the phone or through videoconferencing amid a pandemic. It will include clinical material that illustrates a patient’s negative response to switching to teleanalysis and his reactions to the global pandemic, the analyst’s countertransference, and how considering their meanings allowed for the analytic work to continue and deepen.

In certain cases, and under certain conditions, extremely useful analytic work can be done on the phone or through videoconferencing. Contrary to what some critics of teleanalysis maintain, with patients who are motivated and can make use of analysis, physical distance between analyst and patient and/or occasional technological difficulties do not limit or preclude successful analysis. Clinical material from three teleanalyses demonstrates various conditions that help make teleanalysis useful. Instead of being a disadvantage, the juxtaposition of the experience of the “tele” and the in-person settings (in occasional in-person sessions) provides increased and unique opportunities for analysis.

À partir de matériel détaillé et approfondi extrait de séances de supervision qui ont eu lieu dans le monde entier (étudié dans le cadre des groupes « Évaluation de la Fin de la Formation » [EFF]), cet article montre que les superviseurs sont sujets à des mouvements contre-transférentiels intenses, multiformes et variés, et parfois même continus, qui empiètent sur leur capacité d’évaluer les progrès des candidats. Les sources multiples, externes et internes, de ces interférences sont examinées ici. Les auteurs avancent l’idée que les mouvements contre-transférentiels des superviseurs et leurs manifestations via des mises en acte en parallèle demeurent sous-estimés et inutilisés, de même que leur impact et les informations qu’ils contiennent. Les auteurs soutiennent que la reconnaissance, l’endiguement et l’utilisation de ces phénomènes parallèles et des mouvements contre-transférentiels en supervision sont essentiels pour pouvoir évaluer les progrès des candidats et leur capacité de valider leur cursus. Ils décrivent également les signaux les plus courants de ce type d’enchevêtrement qui altère la fonction évaluative du superviseur et proposent trois solutions « tierces » pour aider les superviseurs à utiliser leur contre-transfert à bon escient : auto-supervision, consultation et mesures de correction institutionnelles.

Utilizando material detallado y de profundidad, de horas de supervisión de todo el mundo (explorado en los Grupos de evaluación de fin del entrenamiento), este trabajo muestra que los supervisores están sujetos a múltiples, diversas y, a veces, continuas contratransferencias intensas e intromisiones en su capacidad para evaluar el progreso de los candidatos. Se exploran las múltiples fuentes externas e internas de estas intromisiones. Se sugiere que las contratransferencias en la supervisión y su manifestación en escenificaciones paralelas permanecen poco reconocidas, su impacto subestimado y la información que contienen subutilizada. Se argumenta que el reconocimiento, la contención y el uso efectivo de los fenómenos de procesos paralelos y las contratransferencias en la supervisión son esenciales para evaluar la progresión de los candidatos y su suficiencia para graduarse. Se identifican algunas señales comunes de tales enredos en la función de evaluación del supervisor. Se ofrecen tres remedios, cada uno de los cuales proporciona un "tercero", para ayudar a los supervisores a hacer un uso efectivo de su contratransferencia: la auto supervisión, la consulta y los correctivos institucionales.

Given that surveys, as well as frequent observations by institute faculty, indicate that many candidates have difficulty finding control cases and maintaining immersion and that many graduate analysts face similar challenges, it would seem that psychoanalytic training does not prepare candidates adequately for finding patients and practicing analysis while in training and, for many, after they have graduated. Although external challenges are formidable, it is by identifying and making use of internal challenges to finding cases that candidates can develop an analytic mind: the identity, approach, and skills necessary not only to graduate but to have the choice to practice clinical psychoanalysis post-graduation. Some of the internal challenges and their manifestations in different phases of initiating analysis (referrals, initial consultation, recommendation) are discussed and two detailed examples are offered to illustrate the productive use of candidates’ countertransferences in finding cases and maintaining immersion. Finally, recommendations for institutional solutions are provided.