PRACTICE NOTE: ON THE USE OF TELEPHONE AND/OR VoIP TECHNOLOGIES IN ANALYSIS
This is a different document from the IPA Procedural Code regarding Remote Analysis in Training
. It is not a procedural document, what we are proposing is a space for reflection and a number of considerations for IPA members to consider in view of the widespread diffusion of Telephone and VolP technologies (eg. Skype, GoToMeeting, etc) in analysis (ie. “remote analysis”). Such considerations have been elaborated together with colleagues who have experience with these modalities.
Our aim is to open up a dialogue, a debate among colleagues in the spirit of further research, of sharing common experiences in meetings and congresses and of sharing the vast amount of literature already available on the topic. It is only if we continue to observe and to study, to exchange experiences and discuss the problems we face, that we can find better responses. The considerations we propose are quite basic and may be found to be too basic by colleagues who have experience in these modalities.
We emphasize that analysis is conducted ‘in the room-in person’ and that other forms of analysis should be pursued only in exceptional circumstances.
1. Analysts working with any form of remote analysis should not assume that all patients are able to sustain it. For example patients who have suffered early separation and severe trauma may not be indicated for this approach. As we know - new areas opening up to psychoanalysis often are areas where people have suffered major historical traumas. It follows that it is important to evaluate whether the analysis is clinically or ethically counter indicated. The initial interviews become crucial in this respect. They should allow a careful evaluation of the psychic functioning of the person and of his/her defensive system.
2. It is essential that an analysis which is intended to continue remotely should begin in person and that analyst and patient meet in person as much as possible and at least once a year. The longest possible period of ‘in the room’ analysis would allow to anchor the transference, facilitate the transference and counter transference processes and allow both analyst and analysand to experience the emotional impact of each other’s ‘full presence’.
3. Unavailability of time and difficulties of travel may be increasing in significance as obstacles to psychoanalysis ‘in the room’, but it is the IPA’s view that remote analysis should be considered only when geographical distance is a real and insurmountable difficulty.
4. The analyst should consider discussing with the patient the experimental nature of methods involving telecommunications, the difference between remote analysis and 'in the room' analysis, and the reasons for choosing this modality. One of the concerns is that, especially in countries new to psychoanalysis, patients may come to believe that this is the way in which analysis is usually practiced.
5. Experience suggests that experienced analysts, with a secure internal setting and a solid enough analytic identity can better withstand an external setting which may be less secure, more unpredictable and more easily disrupted by technological problems. The IPA wants to underline the impact that a different setting – at times more ’fragile’ – may have on the containing and interpretative function of less experienced analysts who are faced with situations for which they had little or no training or clinical discussions.
6. Careful consideration should be given to the continuity and privacy of the setting, so that the analysis is always conducted in the same private place, and not in public places, cars, internet cafes etc.
7. The analyst needs to be aware of the cultural, social and educational context of the patient and have some knowledge about the mental health system of the patient’s country of origin in case of suicidality or the need for hospitalization.
8. There are issues regarding security, privacy protection and confidentiality over all form of telecommunications, including fixed and mobile telephones, VoIP applications, email, and any other application which use the internet. These issues need to be considered and analysts/patients/supervisees need to make themselves aware of them before commencing treatment. Analysts must satisfy themselves that they understand the limits of the security provided by the technology they and their patients are using and the limits of their capacity to protect the patient's confidentiality. They should be aware that in psychoanalytic work undertaken using telecommunications the patient's confidentiality cannot be guaranteed. Threats to confidentiality are of a different nature in the different settings.
9. It is hoped that discussion groups can be held during IPA and Regional Congresses for colleagues to share their work and their experiences and be informed about recent literature and research. The aim is to explore the nature of the remote analytic encounter and to see if there are significant differences from ‘in the room’ and if so, in what way we are able – if at all- to make modifications or compensations for an analytic process to be set in motion.
The Board approved the removal of references to “Skype”, January 2017.
The Board approved an amendment to the final sentence of para. 8, June 2020.
The Board approved two new final sentences for para. 8, July 2021.
*This change record is for background information only and does not form part of the Procedural Code. If there is any conflict between a statement in the Procedural Code and a statement in this change record, the change record will be disregarded.