Screen Relations: The Limits of Computer-Mediated Psychoanalysis and Psychotherapy

by Gillian Isaacs Russell

Increased world-wide mobility and easy access to technology means that computer-mediated communication is being adopted rapidly and uncritically by Psychoanalysts and Psychoanalytic Psychotherapists. Despite claims of equivalence between mediated and shared environment treatments, there has been no research on the efficacy of technologically-mediated treatments. Can an effective therapeutic process occur without physical co-presence? What happens to screen-bound treatment when, as a patient said, there is no potential to "kiss or kick?" Our most intimate relationships, including that of analyst and patient, rely on a significant implicit non-verbal component, carrying equal or possibly more weight than the explicit verbal component. How is this finely nuanced interchange affected by technologically-mediated communication? The author draws on the fields of neuroscience, communication studies, infant observation, cognitive science and human/computer communication studies, finding the common ground where they intersect with psychoanalysis in their definitions of a sense of presence, upon which the sense of self is dependent, to explore these questions.To this emerging body of literature and research was added a collection of ethnographic key informant interviews with senior psychoanalysts experienced in computer-mediated treatment. This new data reveals surprising, and non-intuitive, elements.Based on these findings, the author makes a series of valuable clinical recommendations for practitioners using computer-mediation, helping them to anticipate the particular gains and losses of which they must be aware in order to be most effective.

224 pages, Kindle Edition

First published January 31, 2015

About the author

Gillian Isaacs Russell is a UK-trained psychotherapist and psychoanalyst. She is a member of the British Psychoanalytic Council, the British Psychotherapy Foundation, the American Psychoanalytic Association, the International Psychoanalytical Association and has been in private practice since 1988. She has been on the Editorial Board, Book Review Editor, and presently on the Reviewing Panel of the British Journal of Psychotherapy. She recently co-edited a special issue of "Psychoanalytic Perspectives" on psychoanalysis and technology. She served on the COVID-19 Advisory Team for the American Psychoanalytic Association and is the recipient of the Association's Distinguished Service Award.

She became interested in computer-mediated treatment when moved she from the UK to a remote part of the USA in 2008 and continued to supervise clinicians in the UK by video-conferencing. Subsequently she joined the faculty of the China American Psychoanalytic Alliance, and taught, supervised, and treated Chinese mental health professionals doing a distance psychoanalytic psychotherapy training via computer-mediation. Dr. Isaacs Russell was intrigued, puzzled, and concerned by the differences she perceived between technologically-mediated treatment and her experience of being bodies together in a shared environment. She began research, drawing on her wide experience providing and supervising screen relations based treatments and her extensive ethnographic study of psychoanalytic clinicians and their patients to ask crucial questions lurking on the digital frontier: Can an effective therapeutic process occur without physical co-presence? What happens to screen-bound treatment when, as a patient said, there is no potential to "kiss or kick?" How is intimacy affected by radically altering the balance between implicit non-verbal communications and the explicit verbal?

These questions are particularly urgent in the 21st century when Psychoanalysis faces a profound irony. Increasing mobility, the emergence of modern economies and fast-paced lives are accelerating demand for "screen relations" based treatment. In response, many psychoanalysts are embracing technologically-mediated treatment. Many now make a claim of functional equivalence between mediated and co-present treatments. However, this comes at a time when authorities on how technology shapes relationships are voicing serious concerns about the damage technological mediation does to both intimate connection and reflective solitude. It is time for a deeper psychoanalytic exploration of what actually does and does not happen in technologically-mediated treatment, so as to better weigh the gains and losses of screen relations.

Screen Relations explores these questions through the lens of neuroscience, communication studies, infant observation, cognitive science and human/computer interaction. It finds common ground where these disparate disciplines intersect with psychoanalysis in their definitions of a sense of presence, upon which the sense of self and experience of the other depends. This new data reveals surprising and non-intuitive elements, providing a rich knowledge base for better understanding how people experience screen relations based treatments. Embedded throughout the book are the movingly clear voices of clinicians and patients themselves, describing their experiences using technology for treatment.

Dr. Isaacs Russell speaks and teaches internationally on the subject of technology and its effects on healthcare. She currently lives with her family in Boulder, Colorado.