ABSTRACT

Psychotherapists in the United States routinely use the telephone as the most usual, practical, and efficient way to screen requests for treatment, arrange appointments, and make referrals. Through tone of voice, manner, and ease of communication this telephone communication conveys an impression of both therapist and potential patient (Zalusky, 2000). The experience of each other during the telephone call includes all the elements—resistance, defensive functioning, alliance, and transference and countertransference—that will colour the subsequent therapeutic relationship, or end it before it begins. However, psychoanalysts who do use the telephone to initiate the therapeutic contact have mainly discouraged its use between sessions and eschewed telecommunication as a legitimate setting for the conduct of psychoanalysis. In Chapter Six I gave a detailed account of those analysts who pioneered the use of the telephone, the videophone, and the headset and showed how, even without visual cues, erotic, negative and paranoid transference could ripen, might be intensified, or be hidden from view, as it is in in-person sessions, and could be interpreted effectively (Aronson, 2000a, 2000b; Leffert, 2003; Lindon, 2000; Saul, 1951; Zalusky, 2005). A number of chapters have described how it is possible for the therapist to add visual input from a webcam in sessions that occur using Skype rather than the telephone. With or without visual input, each participant creates and sustains a mental representation of the other in fantasy, and in this way, a new type of analytic process develops (Zalusky, 2003a, 2003b). Nevertheless, until now, even supporters of teletherapy have tended to view it overcautiously as second best, a therapeutic compromise, a trauma, or merely better than nothing, a view that diminishes its value (Benson, Rowntree & Singer, 2001; Lindon, 2000; Sachs, 2003; Zalusky, 1998).