Spatially Distant but Emotionally Close: A Personal Reflection on Psychoanalytic Distance Training

A myth in the ancient Persian book A Thousand and One Nights says that Prince Hussain traveled to India and bought a magic carpet. Whoever sat on the carpet and wished to be taken up and set down on another site would, in the twinkling of an eye, be borne there, be it near to hand or many days’ journey away.

Every Friday afternoon, I sit on my magic carpet and order it to fly me to Chicago. It doesn’t happen quite like this, but it feels similar when I sit at my desk in Tehran and, by clicking a key, join a class in the United States. Every time I do this, it feels like magic. Thanks to technology, I can transcend the limits of geography to be with people in a faraway place who share the same passion, cause, and dream. Psychoanalysis is the common thread that so powerfully connects us.

I live in a country with no accredited training program or official link to the international psychoanalytic community—a country in which, regardless of the scarcity of supply, demand for psychoanalysis has steadily increased. In a culture with such a rich history of storytelling (Movahedi and Moshtagh 2019), Iranian patients love to tell their stories and benefit from the wisdom offered by psychoanalytic thinking. Anything related to psychoanalysis, from theory to practice and the application of theory to art and literature, attracts such an enthusiastic audience that events with psychoanalytic themes are sold out almost immediately.

Being a distance psychoanalytic candidate isn’t my first exposure to technology in the service of psychoanalysis. Around a decade ago, while on the couch during my first analysis in Tehran, I began supervision with an Iranian senior analyst in Boston. Essentially, that was how I learned the theory and technique of working as a psychoanalytic psychotherapist. Starting with only the telephone, I entered into one of the most vital analytic relationships of my career. That relationship, which is still spatially distant, continues to be fruitful today.

I had two supervision sessions each week on the phone, and later in an audio Skype call, along with three or four in-person sessions every year. After eight years on the couch and termination of my first analysis, I decided to undertake a second analysis with a senior psychoanalyst in Toronto. This analysis also started on the phone, with no in-person contact. It was several years before I could obtain a visa and travel to Toronto to see my analyst in person. In the meantime, I took courses online, participated in group and individual online supervision with psychoanalysts from different schools of thought, accepted online patients and supervisees, and eventually became an online analytic candidate. More than ten years of experience in different analytic roles has convinced me that being spatially distant poses no contradictions to psychoanalysis, as long as both parties—patient and analyst, supervisee and supervisor, candidate and instructor—are willing to listen, hear, and be heard emotionally.

Even before starting my training at the Chicago Psychoanalytic Institute, I was aware of the controversies surrounding the legitimacy of distance training. At first, the main psychoanalytic organizations would not grant membership to distance candidates unless they had at least a year of four-times-weekly in-person analysis on the couch. This requirement must have been formulated with American or European applicants in mind, people with easy access to analysts. This prerequisite would permit only a handful of individuals under special circumstances to become certified psychoanalysts and members of the major psychoanalytic organizations. Fortunately, however, some institutes replied positively to requests and began accepting international students online. These are APsaA- and IPA-approved training programs that allow international candidates to sit in classes with local candidates—yet until very recently only local candidates were granted full membership at those institutes. Distance candidates were granted only associate membership, even though they were required to meet similar standards for admission, took the same courses, fulfilled the same requirements for training analysis and supervision, and underwent the same evaluation process the local candidates did.

In some respects, it’s not accurate to say that distance candidates must perform “the same” as local candidates. Being spatially distant means that “keeping well, keeping alive, keeping awake” (Winnicott 1965, p. 166) during training is more difficult for them than for local candidates. Distance candidates can’t help but feel a certain level of exclusion, especially if the instructors are not familiar with the technology and/or have difficulty engaging students from different cultures; in such circumstances it is imperative for distance candidates to actively make their presence known to be able to contribute in class discussions. Thus, they must navigate major challenges such as speaking and writing in a second language, learning socially acceptable ways of relating in a different culture, managing often great time differences, and integrating culturally diverse views of inter- and intrapsychic problems. It takes passion, courage, and commitment to succeed in that role. Nonetheless, distance candidates are often treated as second-class citizens in the psychoanalytic community because, as Essig (2012) likes to argue, we lack “direct, embodied interaction” in our training analysis and supervision. In his view, our experiences are second-rate and unreal. Our experiences are “technologically mediated,” and as such we suffer from Simulation Entrapment Disorder (SED). ¹ The only experience that is “real” and “unmediated,” for Essig, is what occurs between two physical bodies in the same room, a highly questionable assumption indeed. This belief, ironically, turns Lacan’s theoretical triad upside down by relegating the “imaginary relations” in the room between the two actors into some experience at the register of “real.”

Curiously, in a discipline that prides itself on being a talking cure, an emphasis on vision and body has replaced the importance of voice and language as the main carriers of human affects. Gutierrez (2017) has recently suggested that videoconference tele-analysis presents a hindrance to reaching states of unintegration and interferes with symbolization. This, to her, stems from “the greater ego demand [videoconferencing] imposes on both members of the analytic dyad to resolve the split brought about by the device” (p. 98). There is no doubt that some analysts and analysands may have difficulty using digital devices, and even email, but that is not evidence that distance learning and analysis cannot be successfully conducted. Bayles (2012) argues that technologically mediated relationships can’t function properly because a lack of vision or insufficient seeing impairs the proprioceptive senses, and this, in his view, damages the entire analytic dialogue. This argument perpetuates an old confusion between sensation/perception and observation/inference (Searle 2015). The argument implies that a blind person cannot become an analyst. We can “see” by listening and “hear” by seeing. Moses (2005, cited in Bayles 2012) suggests that distance analysis only serves the analyst’s narcissism, while Essig (2015) reduces human relationships “through” screens to “screen relations.” Most of these writers view concepts such as “presence,” “absence,” “analytic space,” “intimacy,” and the “object” in “object relations” unproblematically and, at times, even concretely. There are even bizarre interpretations of “containment” in which it is alleged to materialize only when two physical bodies are in close proximity.

In “The Psychotherapy of Hysteria” (1895), Freud elaborates on how he abandoned his attempts to use the body and discovered the importance of “psychical work” (p. 268) and “turning to words” (p. 280). From that point on, listening and hearing became the heart of psychoanalytic treatment. In this process, words are used to shape and change the person’s experience. It’s through the use of language—and not through vision and seeing—that we achieve the aim of analysis. Scharff (2013), in discussing the advantages and disadvantages of tele-analysis, suggests that focusing on speech as the only medium of information helps the analyst “become more intent on listening” (p. 69). Ogden (1998) reminds us that

“the analytic setup, with its relative absence of visual cues, its unusual rhythm of dialogic give and take, its strong emphasis on the use of language in the service of the exploration of the conscious and unconscious experience of the analysand, powerfully contributes to a greatly heightened sensitivity to the sound of the analysand’s voice” (p. 446).

Voice resides at the intersection of body and mind. Heavily influenced by emotions, voice, as an instrument for connecting with the outside world, provides the analyst a wealth of conscious and unconscious information. Each person’s voice—its tone and rhythm, and the pauses and inflections with which the person speaks—has a unique musical quality. In Listening with the Third Ear, Reik (1948) emphasized that “a voice that we hear, though we do not see the speaker, may sometimes tell us more about him than if we were observing him” (p. 136). The musical aspect of a person’s voice evokes a “current of preverbal affect” (Faber 1996, p. 421) in the listener, reminiscent of early childhood interactions with caretakers (Wright 2009).

This is the point overlooked in the argument against distance analysis and training. The information the analyst gathers from bodily presence is important, but even then the analyst’s job is to hear the patient’s unconscious communications. If an analyst, for whatever reason, is unable to hear the patient’s voice and unconscious communications, the analysis is bound to fail whether the patient is in the room or on the screen/phone. The psychoanalytic literature provides numerous instances of in-person analysis in which the analytic process has ended in various forms of impasse, destructive enactment, or total failure. When a patient complains to the analyst that You do not seem to be here, she or he does not refer to the physical space. The analyst and the patient may be physically close in the room but emotionally far away. While the importance of a procedural level of interaction through body (Bayles 2012) is undeniable, to assign the literal bodily presence such a vital role is highly questionable; it is certainly not based on scientific evidence.

The same argument applies to supervision. A supervisor with a trained ear and enthusiastic mind can hear an analysand’s unconscious communication through listening to a candidate’s presentation. The fascinating aspect of distance supervision—provided that supervisor and supervisee form an efficient “learning alliance” (Blomfield 1985)—is that the patient’s unconscious never gets “lost in translation.” The fact that most distance candidates do not speak their native languages in their supervision is not a hindrance to reaching a shared psychoanalytic understanding that benefits both patient and candidate. This is especially true when the supervisor’s style is more dialectic than didactic (Crick 1991). What happens in the consulting room finds its way to the supervision session through the unconscious transmission of prevalent dynamics. The supervisor can decipher patterns of interaction, the vicissitudes of the transference-countertransference matrix, and theoretical and clinical blind spots while listening to a candidate’s presentation of a case. The language of psychoanalysis gradually fills in the gaps and makes it possible for the candidate to benefit from the supervisor’s knowledge and experience.

I understand that two senior analysts have recently proposed to study the differential effectiveness of body-to-body versus online analysis, supervision, and education. Although as an Iranian I cannot, per President Trump’s order, produce my physical body in the “real” space of their study group, I would wholeheartedly volunteer to work with them online. Of course, I would participate only if they are thinking of setting up a double-blind experimental design by randomly assigning patients and analysts and supervisors and supervisees to different experimental and control groups; these would include body-to-body, video only, audio only, texting only, and combinations of these formats.

Analysts’ theories of therapeutic action and their attitudes toward technology drive many of these arguments. In itself, that form of reasoning represents a “resistance” to change—an interesting topic for psychoanalytic exploration. At times one can hear writers’ disguised anger and frustration with their children who prefer to stay online rather than be in their parents’ physical presence. In contrast, Brottman (2012), in “Whereof One Cannot Speak: Conducting Psychoanalysis Online,” presents a case of masochism in which the patient was too ashamed to talk in the room and had to resort to emails. Brottman describes how she could hear her patient’s need for distance and how she was able to maintain the analytic relationship. Caparrotta (2013) believes that Skype can be a helpful medium for analysis and emphasizes the need to embrace new technologies instead of rejecting them.

Skype and other electronic media can be viewed as normal variants of a human relationship that permits the analytic dialogue to develop. Using this technology may not be easy for everyone, and each analytic dyad must decide whether a distance relationship works for them. Some may not be comfortable working with devices and applications, but this doesn’t mean that the idea should be rejected as illegitimate or nonpsychoanalytic; this is especially true when so many have managed to find their place in this new world. Embracing technological advancements is the only way to establish a global network of properly trained analysts. Confining psychoanalysis within the walls of embodied presence will only weaken the discipline, an outcome no one wants.

How will we negotiate the traditional frame of psychoanalysis in the modern world, with its increasing demand for analysis and training? Insisting on outdated rituals is itself a kind of encounter of the obsessive. As a culture (which includes science and technology), a way of life, and even psychopathology change, so will the frame of any professional practice (Movahedi and Moshtagh 2016).

Perhaps we should all be courageous enough to heed Winnicott: “Mature adults bring vitality to that which is ancient, old and orthodox, by recreating it after destroying it” (quoted in Phillips 1989, p. 5). In that spirit, the March 28, 2019, decision of ApsaA’s Executive Committee to give full candidate membership to distance candidates in clinical training at its institutes is a laudable move toward inclusion and toward widening the psychoanalytic sphere of knowledge and practice.