Online psychoanalytic work

THE LION WHO SAW HIS FACE IN THE WATER

There was once a lion who lived in the desert which was very windy; and because of this, the water in the holes from which he usually drank was never still, for the wind riffled the surface and never reflected anything.

One day the lion wandered into a forest, where he hunted and played, until he felt rather tired and thirsty. Looking for water, he came across a pool of the coolest, most tempting and most placid water that you could possibly imagine. Lions, like other wild animals, can smell water, and the scent of this water was like ambrosia to him.

So the lion approached the pool, and extended his neck to have a good drink. Suddenly, though, he saw his reflection – imagined that it must be another lion.

“Oh dear”, he thought to himself, “this must be water belonging to another lion – I had better be careful.”

He retreated, but then thirst drove him back, and again he saw the head of a fearsome lion looking back at him from the surface of the pool.

This time our lion hoped that he was able to frighten the ‘other lion’ away; and so he opened his mouth and gave a terrible roar. But no sooner had he bared his teeth than, of course, the mouth of the ‘other lion’ opened as well, and this seemed to our lion to be an awful and dangerous sight.

Again and again the lion retreated and then returned to the pool. Again and again he had the same experience.

After a long time, however, he was so thirsty and desperate that he decided to himself: ‘Lion or no lion, I am going to drink from that pool!’

And, lo and behold, no sooner had he plunged his face into the water than the ‘other lion’ disappeared!

(Shah, 1983, p. 118-119)

When Idries Shah did a documentary programme for the BBC, he told a group of children this tale and subsequently received a lot of positive feedback from parents. They related to him that it helped their children with some of their fears of the unknown or unfamiliar. These Eastern teaching stories are different from the more gruesome Western fairy tales of the Brothers Grimm and Hans Anderson. They are meant to have an impact rather than in need of immediate interpretation which might, in fact, take away some of the intended impact.

They are not only useful for children, but would apply to many situations in life and can, of course, apply to those of us who have done a journey in psychotherapy or analysis and how it all started. Those who are considering embarking on such a journey of self-discovery and are willing to become more conscious of their shadow-side and their unconscious, could also see the meanings to which the story refers. Psychotherapists are all too familiar with the fantasies people have about ‘seeing a therapist; a psychologist or psychoanalyst’: many projections precede the decision to actually take the plunge and luckily to then discover it is not so awful after all.

What would it be like if we enter into a process of this nature by plunging into online analytic work? Why would we do it and for whom is this is a good alternative to visiting the analyst in their office? In modern life so much transpires via the medium of computer screens that we may conclude that this is a possible option? What would be the differences or are there divergences and convergences without the need to dismiss the option?

For me, this option came about after emigrating from Europe to Australia, where distances are often a hindrance to working face-to-face in an office.

In the process of setting outlines for training, an agreement with colleagues led to the first clear statement to allow supervision to take place via telephone, which was in those days the main technical medium. One can imagine how things changed when online work became possible and how useful it was to allow such communications to take place via the new medium of Skype.

Over the years I have increased my experience in working online and have done years of actual online analytic and therapeutic work with many people from various countries, cultures and time-zones. Personally, I have experienced this as a useful option and wish to remain supportive of this possibility for as long as I can see benefits outweighing reservations. It is high time for more debate and conversation about this new, modern, option and to see what the restrictions, disadvantages are as well as highlighting the real advantages and new potential.

Before we start I would like to refer to the fact that we should be speaking from a point of view where the emphasis is on ‘understanding’ rather than ‘explaining’. This is essential because it stands at the centre of the many misunderstandings about psychology as a science. In order to have a rigorous science, there should be consistency between the nature of the question of the scientist/researcher and the methods used. In psychology, we have seen that a large proportion has been an imitation of a natural scientific method, i.e. quantitative methods with statistics at times where qualitative methods would answer the question more rigorously. This all leads back to the dualism, ever since Descartes’ ideas of dualism took hold in the West. We shall briefly turn to one particularly unfortunate outcome next.

Psychology: a human science or imitation of natural science?

In psychology, two kinds of psychology arose in the year 1874, the birth year of psychology as a ‘science’ (according to the history of mainstream psychology, with the foundation of the laboratory of Wilhelm Wundt). The other form is seeking to understand the soul from a phenomenological perspective (Brentano called his major work “Psychology from an Empirical Standpoint” and was published in that same year of 1874).

Apart from Husserl, there were other thinkers, especially during the beginning of the 20th century, such as Dilthey (in education) and Karl Jaspers (in psychiatry), who emphasized the importance of the distinction between ‘explaining’ and ‘understanding’. It relates to such basic questions on ‘meaning’ versus ‘objective data’, which are always part of debates on the nature of human phenomena. For instance, in order to understand the question of what it means to be frightened or angry, the question might be best answered by a human scientific approach, i.e. the researcher would do well to try and understand the phenomenon of anxiety or anger rather than answering the question via measurements of the variation in levels of adrenaline or nor-adrenaline flowing in the bloodstream.

In this context, the psychoanalysis should be conceived of as a human science as it is concerned with meaning rather than with objective data.

In psychology and psychoanalysis (from whatever background, be they Freudian, Kleinian, Jungian, Post-Jungian and Post-Kleinian etc.), this critical distinction is essential if one does not want to get trapped into two different discourses where the arguments are always interspersed with assumptions that will never meet.

Basic distinctions between human beings as objects and subjects, between ‘causal explanations’ and ‘understanding’, should be explored and ultimately put into the modern context of psychoanalysis as a human science where ‘relationship’ is an essential aspect of psychoanalysis. The latter is illustrated by the most modern theories of psychoanalysis as explored by brain scientists and psychoanalysts. All of these theories refer to the essence and importance of ‘attachment’, which is, of course, essentially to do with relationship. That being the case it is only part of a rigorous human scientific enterprise to allow for qualitative descriptions to understand psychological phenomena, rather than pretend that the scientific, neuro-physiological approach can replace psychoanalytic understanding. This latter does not mean to say that neuroscience cannot assist us in understanding certain clinical conditions. It can explain a lot, but to understand the phenomena of a psychic nature we also need to remain true to human science.

This movement where psychology is described as a human science is already decades old and has led to associations and societies which deal with ‘qualitative research’ as opposed to the compulsion to use non-descriptive, quantitative methods to answer questions which deserve descriptions of meaning.

This will suffice to introduce the descriptions of the following experiences around online analytic work. I will describe and stay at the first level of description, i.e. before it can be used as material which can lead to descriptions of the essential components. Other aspects of qualitative research will be present though, which will be referred to as style, level, type of description of the experiences.

Online Analytic Work: with Whom?

There are, of course, varying types of motivation to enter into an analytic process and people plunge into the unconscious process with their own historical background and meaningful aims.

On the practical level, the first aspect is the availability of an analyst in the region of where people live. Even if analysts may be within a region that can be reached physically, the other aspect can be that it is difficult to do so in practice.

For instance, in my case, since Jungian analysts are not available in every country or region, people will look for other options and find analysts or therapists who are available online. At times people reached me rather than a geographically nearby analyst, because of their own busy schedules to do with their work. In big cities in modern life, traffic and transport can be so time-consuming that people cannot afford to take the journeys to the practise of the analysts in the region. The hassle to reach the office would include difficulties with parking, interruptions from work during travelling time, in short problems in meeting the minimal requirements of the analytic setting. From my own history, I can recall the long distances I travelled from a Dutch city to Brussels to do my training analysis. This was possible to do decades ago with much lower volumes of traffic and cooperation from the hospital employers. Nowadays such cooperation from employers to free up time and support travel expenses is rare. To meet the analyst or therapist in their practice is, of course, an optimal situation, but time has moved on and people can nowadays opt for a setting which was impossible in the old days.

The setting or framework changes once we accept that we can work online and still do meaningful useful, analytic work. The setting is often attractive enough for the client, because many people have more freedom in terms of choosing their time as well as place. To be able to be in one’s own environment to do the therapeutic work or the process of individuation (or self-development), is often good enough. The meeting is still ‘face-to-face’, but there is of course not the option to do analysis-on-the couch. We are speaking of meetings, encounters, where the presence to each other is of a different mode. One is present to each other, although the two people involved are in their own surroundings.

The contact is essentially an encounter between two people who have agreed to work together and have established that they can do this within this framework. The analyst or therapist has the responsibility to enter into this kind of arrangement after establishing that there is a sufficiently strong foundation to work in this way. This means that when working with clients with psychopathological problems, these problems are not of such a nature that they would be risky or even dangerous when the two cannot be in the same room. It is always a decision to be made anyway, whether one can work with a suicidal or psychotic patient, be it in the same room or via an online connection. Overall, there are no clear and definite guidelines about what is possible, but of course each professional has to meet ethical standards. Ethical codes are usually like guidelines, but actual judgments about what is ethical or not would demand a knowledge and understanding of the situation at hand. Abstract rules or codes are there to protect one from trespassing clear boundaries.

Personally, I work and have worked in the same office space with such clients, but do work with clients online who are not in immediate danger of psychosis or impulsive suicidal states.

In fact, most of my clients these days are people who wish to improve their own lives and develop themselves personally as well as professionally via their own analysis or supervision. I also work with people who have depressive moods and make sure that there is support in their own locality if such a need arises to start or change medication.

In terms of training analysis, i.e. the process each candidate in training to become an analyst has to undergo, I would say that online analytic work should not replace the full training analysis. There have been times that online work during training analysis has been useful, but mainly to supplement the times when the two cannot meet in person (holidays, absences due to temporary placements elsewhere etc.).

The latter is also important because the full training analysis offers the opportunity to allow for psychic regression to take place at a level where the upcoming analyst has the experience necessary to work with psychiatric patients (especially borderline patients). To what extent online work can replace this kind of work with such patients would be interesting to explore and debate, but more qualitative research will be needed to describe the limitations.

In my experience, without those clinical considerations and reflecting on the work with people from various backgrounds and aims, this online work has been favourable. It is enriching to be able to work with people from different cultures too, so whether somebody is in Singapore, China, USA, Jordan, France, Indonesia or Australia, it is a matter of adapting to different time zones and commitment.

Transference

Let us turn now to the essential nature of the analytic work and reflect on the differences between such a phenomenon in the life situation or online. What are the convergences and divergences, if any, in all these components of analysis: transference; projection; resistance; dream analysis? First, there is this essential component of transference.

The emphasis on ‘relationship’ in analysis (Freudian, Jungian or other) is the phenomenon of what has been named ‘transference’.

When Freud discovered that (post-hypnotic or otherwise) suggestions did not lead to a permanent cure and that, in fact, the patient would develop an intense range of feelings towards the analyst, he started to investigate this fascinating phenomenon closer and came to understand how essential this relationship became for the healing process.

Basically, transference feelings, thoughts and ways of relating, stem from what are considered ‘unresolved issues’ that have been part of a person’s life without being fully aware of what they are and why they persist.

The full transference experience relates to the way one has experienced a relationship, usually with the parents or other primary caregivers.

For instance, a patient who has been abused will, unconsciously, relate to the analyst in a way where a ‘repetition’ in symbolic form, can come into being in their relationship. If the analyst is not fully aware either, it leads to counter-transference feelings which at times constellate this old type of ‘abusive pattern’, albeit in a more symbolic way, without necessarily any form of ‘acting out’. In the case of a patient who has been sexually abused, for instance, the analyst or therapist might unconsciously ask ‘penetrative’ questions (a mistake often made by inexperienced therapists). At the conscious level, the therapist thinks it is a good idea to change the pattern by asking these questions, believing that this is what psychoanalysts do in order to aim at a catharsis (release of emotional traumatic emotions). The more experienced therapist would somehow know (or intuit) the time is not ripe for such release of emotions and that it is more meaningful at that time to reflect on the impulse to ask such intrusive questions. This counts both for psycho trauma (Freud aims here at what took place at the fantasy level) as well as for real physical traumatic experiences.

This is just one example in the clinical field and the question would be if this phenomenon can be worked through while the setting is ‘online’.

The question of whether transference comes into being when working via this medium presupposes that it is a necessity for two people to meet in person for such feelings or fantasies to arise. Needless to say, it does arise and is not something that can be easily seen by the client as transference is by definition an unconscious event. It is akin to projection, although it is not a defence, but a phenomenon which enables one to work through certain difficulties or hindrances in the process. Clearing complexes or other matters which are in the way of psychic liberation is what happens in the relationship. This work depends on the art to spot it and to handle such feelings and fantasies in a way where both parties understand what is happening. It is the task of the analyst to perceive them in order to make them conscious.

All this certainly takes place in online work and serves the process of individuation (as Jung called this development of the Self).

Like all phenomena in relationship, there are different types and levels of transference, just as they have their own typical forms of resistance with their own intensities. Overall the aim should be to come closer to the truth about oneself and this process takes place when there is sufficient love to transform drives to power and other detrimental factors. The process means a transformation from the literal level to the symbolic level (about which I wrote more elsewhere (De Koning, A., 2017)

Working with and analysing dreams: ‘dreamwork’.

I am using this word ‘dreamwork’ to indicate that a certain kind of dream analysis has more to do with the embodiment of dream images than the interpretation. It is a way of allowing the client to imagine their dream again from scene to scene while paying attention to the bodily feelings and sensations that may arise. This term was coined by my colleague Robert Bosnak and his book entitled ‘Embodiment’ is an excellent description in detail of many examples of working with dreams in this alternative way (Bosnak, R., 2007).

The method lends itself well to working online and has little to do with the clinical emphasis on dreams as is popularly conceived. No quick ‘Freudian’ or ‘Jungian’ interpretations are given and interpretation gets a second place in the process. The movement of walking through the dream with the client and the use of a form of active imagination is sufficient to allow the impact of the dream to do its work without too quickly raising it to the level of cognitive interpretation.

The emphasis is not the reality of the dream image, which is essential to the narrative of the dream. To allow the images or symbols to be contemplated or imagined again in the conscious state, can help to be present to what is taking place and enter the story without too many presuppositions of what theory should fit in with it. The body is, after all, not only an object or something we have, but we are also this body or body-subject. We can learn from what these dream personalities are as they tend to be bearers of meaning, no matter how peculiar they may appear at first glance. It is best to approach the dream images without prejudice or theory and allow such phenomena to unveil themselves to us. The embodied imagination assists in being more involved and centred than the ex-centric position of the reflecting mind.

There are certain techniques which can make this embodiment stronger, such as amplification where the image might be blown up or exaggerated in order to experience the strength and the impact of what might appear as a weak image. Working with dreams in this way is fine to do online and it does not require the person to be present in the same room.

Conclusion

In short, the possibility to work analytically online or there and the essential components of the process of (therapy or individuation) are the same. The differences are more in the modality, the way in which one is present to each other. This is noticeable when we consider the aspect of silences during the process: in the practice room silences might be a bit longer, but the actual perception of the silence and intuiting what kind of silence it is, does not have to differ. It also depends on what cues are used by the analyst: some are better at picking up visual cues and others listen to more nuances in speech and intonations.

It will be interesting to see more debate and conversation about the convergences and divergences between the two modalities of working and with whom this is a good enough setting. In my own experience over the last few years it has been more and more with people who know something about Carl Jung and wish to develop their own sense of Self and become more aware of their own shadow side in order to become more conscious or pay attention to the spiritual side of our soul.

Literature

Bosnak, R. (2007), Embodiment. Routledge. London and New York.

De Koning, A., (2017), On Love and Truth in Psychotherapy. In Zelda Knight (Ed.), The Art of Psychotherapy. Nova Science Publishers. New York.

Shah, I. (1983), TheMagic Monastery. Octagon Press. London.

Born in Amsterdam (The Netherlands) in 1951, André de Koning completed his doctoral examination in Clinical Psychology at the University of Leiden (1975). He was a Visiting Scholar and Lecturer in phenomenological psychology at Duquesne University, Pittsburgh, USA (1974-1975) and a Thyssen Fellow at Heidelberg University, Germany (Department of Psychiatry; 1977-1978). André also worked in the United Kingdom for several years (1975-1977) in the field of Psychiatry.

He completed his training as a Jungian psychoanalyst in Brussels in 1983 and became a training analyst and member of the Training Committee of the Belgian Society for Analytical Psychology in January 1991.

Since moving from The Netherlands to Perth (Australia) in 1994, Drs. de Koning has been involved in the further development of training with the Australian and New Zealand Society for Jungian Analysts and its C G Jung Institute (ANZSJA-CGJI). He was Convener of Training from 1994-2003.

André was a Member of the Executive Committee of the International Association for Analytical Psychology (IAAP) from 1998-2004, and he was President of ANZSJA. Additionally, Drs. de Koning assisted in setting up the Singapore C G Jung Institute and has since taught courses there.

He became a Member of the Netherlands group of Jungian Analysts with a view to assist in founding the possibility of a training there. Presently he is regularly in Europe, but still lives in Perth, Australia and works online frequently.