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Name: NURS_6640_Week3_Assignment1_Rubric

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Excellent

Good

Fair

Poor

Quality of Work Submitted:
The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking.

Points:

Points Range: 27 (27%) – 30 (30%)

Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics.

Feedback:

Points:

Points Range: 24 (24%) – 26 (26%)

Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics.

Feedback:

Points:

Points Range: 21 (21%) – 23 (23%)

Assignment meets most of the expectations. One required topic is either not addressed or inadequately addressed.

Feedback:

Points:

Points Range: 0 (0%) – 20 (20%)

Assignment superficially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed.

Feedback:

Quality of Work Submitted:
The purpose of the paper is clear.

Points:

Points Range: 5 (5%) – 5 (5%)

A clear and comprehensive purpose statement is provided which delineates all required criteria.

Feedback:

Points:

Points Range: 4 (4%) – 4 (4%)

Purpose of the assignment is stated, yet is brief and not descriptive.

Feedback:

Points:

Points Range: 3.5 (3.5%) – 3.5 (3.5%)

Purpose of the assignment is vague or off topic.

Feedback:

Points:

Points Range: 0 (0%) – 3 (3%)

No purpose statement was provided.

Feedback:

Assimilation and Synthesis of Ideas:
The extent to which the work reflects the student’s ability to:
Understand and interpret the assignment’s key concepts.

Points:

Points Range: 9 (9%) – 10 (10%)

Demonstrates the ability to critically appraise and intellectually explore key concepts.

Feedback:

Points:

Points Range: 8 (8%) – 8 (8%)

Demonstrates a clear understanding of key concepts.

Feedback:

Points:

Points Range: 7 (7%) – 7 (7%)

Shows some degree of understanding of key concepts.

Feedback:

Points:

Points Range: 0 (0%) – 6 (6%)

Shows a lack of understanding of key concepts, deviates from topics.

Feedback:

Assimilation and Synthesis of Ideas:
The extent to which the work reflects the student’s ability to:

Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources.

Points:

Points Range: 18 (18%) – 20 (20%)

Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 2-3 course resources to suppport point of view.

Feedback:

Points:

Points Range: 16 (16%) – 17 (17%)

Integrates specific information from 1 credible outside resource and 2-3 course resources to support major points and point of view.

Feedback:

Points:

Points Range: 14 (14%) – 15 (15%)

Minimally includes and integrates specific information from 2-3 resources to support major points and point of view.

Feedback:

Points:

Points Range: 0 (0%) – 13 (13%)

Includes and integrates specific information from 0 to 1 resoruce to support major points and point of view.

Feedback:

Assimilation and Synthesis of Ideas:
The extent to which the work reflects the student’s ability to:
Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings, textbook) and outside, credible resources by comparing different points of view and highlighting similarities, differences, and connections.

Points:
Points Range: 18 (18%) – 20 (20%)

Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice.

Feedback:

Points:
Points Range: 16 (16%) – 17 (17%)

Summarizes information gleaned from sources to support major points, but does not synthesize.

Feedback:

Points:
Points Range: 14 (14%) – 15 (15%)

Identifies but does not interpret or apply concepts, and/or strategies correctly; ideas unclear and/or underdeveloped.

Feedback:

Points:
Points Range: 0 (0%) – 13 (13%)

Rarely or does not interpret, apply, and synthesize concepts, and/or strategies.

Feedback:

Written Expression and Formatting
Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused–neither long and rambling nor short and lacking substance.

Points:
Points Range: 5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity

Feedback:

Points:
Points Range: 4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 80% of the time.

Feedback:

Points:
Points Range: 3.5 (3.5%) – 3.5 (3.5%)

Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 60%- 79% of the time.

Feedback:

Points:
Points Range: 0 (0%) – 3 (3%)

Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity < 60% of the time.

Feedback:

Written Expression and Formatting
English writing standards: Correct grammar, mechanics, and proper punctuation

Points:
Points Range: 5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

Feedback:

Points:
Points Range: 4 (4%) – 4 (4%)

Contains a few (1-2) grammar, spelling, and punctuation errors.

Feedback:

Points:
Points Range: 3.5 (3.5%) – 3.5 (3.5%)

Contains several (3-4) grammar, spelling, and punctuation errors.

Feedback:

Points:
Points Range: 0 (0%) – 3 (3%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

Feedback:

Written Expression and Formatting
The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.

Points:
Points Range: 5 (5%) – 5 (5%)

Uses correct APA format with no errors.

Feedback:

Points:
Points Range: 4 (4%) – 4 (4%)

Contains a few (1-2) APA format errors.

Feedback:

Points:
Points Range: 3.5 (3.5%) – 3.5 (3.5%)

Contains several (3-4) APA format errors.

Feedback:

Points:
Points Range: 0 (0%) – 3 (3%)

Contains many (≥ 5) APA format errors.

Feedback:

Show Descriptions Show Feedback

Quality of Work Submitted:
The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking.–

Levels of Achievement:

Excellent 27 (27%) – 30 (30%)

Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics.

Good 24 (24%) – 26 (26%)

Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics.

Fair 21 (21%) – 23 (23%)

Assignment meets most of the expectations. One required topic is either not addressed or inadequately addressed.

Poor 0 (0%) – 20 (20%)

Assignment superficially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed.
Feedback:

Quality of Work Submitted:
The purpose of the paper is clear.–

Levels of Achievement:

Excellent 5 (5%) – 5 (5%)

A clear and comprehensive purpose statement is provided which delineates all required criteria.

Good 4 (4%) – 4 (4%)

Purpose of the assignment is stated, yet is brief and not descriptive.

Fair 3.5 (3.5%) – 3.5 (3.5%)

Purpose of the assignment is vague or off topic.

Poor 0 (0%) – 3 (3%)

No purpose statement was provided.
Feedback:

Assimilation and Synthesis of Ideas:
The extent to which the work reflects the student’s ability to:
Understand and interpret the assignment’s key concepts.–

Levels of Achievement:

Excellent 9 (9%) – 10 (10%)

Demonstrates the ability to critically appraise and intellectually explore key concepts.

Good 8 (8%) – 8 (8%)

Demonstrates a clear understanding of key concepts.

Fair 7 (7%) – 7 (7%)

Shows some degree of understanding of key concepts.

Poor 0 (0%) – 6 (6%)

Shows a lack of understanding of key concepts, deviates from topics.
Feedback:

Assimilation and Synthesis of Ideas:
The extent to which the work reflects the student’s ability to:

Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources.–

Levels of Achievement:

Excellent 18 (18%) – 20 (20%)

Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 2-3 course resources to suppport point of view.

Good 16 (16%) – 17 (17%)

Integrates specific information from 1 credible outside resource and 2-3 course resources to support major points and point of view.

Fair 14 (14%) – 15 (15%)

Minimally includes and integrates specific information from 2-3 resources to support major points and point of view.

Poor 0 (0%) – 13 (13%)

Includes and integrates specific information from 0 to 1 resoruce to support major points and point of view.
Feedback:

Levels of Achievement:
Excellent 18 (18%) – 20 (20%)
Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice.
Good 16 (16%) – 17 (17%)
Summarizes information gleaned from sources to support major points, but does not synthesize.
Fair 14 (14%) – 15 (15%)
Identifies but does not interpret or apply concepts, and/or strategies correctly; ideas unclear and/or underdeveloped.
Poor 0 (0%) – 13 (13%)
Rarely or does not interpret, apply, and synthesize concepts, and/or strategies.
Feedback:

Levels of Achievement:
Excellent 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity
Good 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 80% of the time.
Fair 3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 60%- 79% of the time.
Poor 0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity < 60% of the time. Feedback:

Written Expression and Formatting
English writing standards: Correct grammar, mechanics, and proper punctuation–

Levels of Achievement:
Excellent 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
Good 4 (4%) – 4 (4%)
Contains a few (1-2) grammar, spelling, and punctuation errors.
Fair 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3-4) grammar, spelling, and punctuation errors.
Poor 0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Feedback:

Levels of Achievement:
Excellent 5 (5%) – 5 (5%)
Uses correct APA format with no errors.
Good 4 (4%) – 4 (4%)
Contains a few (1-2) APA format errors.
Fair 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3-4) APA format errors.
Poor 0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors.
Feedback:

Total Points: 100

Name: NURS_6640_Week3_Assignment1_Rubric

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Exit

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Required Readings

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

· Standard 2 “Diagnosis” (pages 46-47)

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

· Chapter 5, “Supportive and Psychodynamic Psychotherapy” (pp. 225–238 and pp. 245–258)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Young, J. M., & Solomon, M. J. (2009). How to critically appraise an article. Nature Clinical Practice. Gastroenterology & Hepatology, 6(2), 82–91.

How to Critically Appraise an Article by Young, J.; Solomon, M., in Nature Reviews Gastroenterology & Hepatology, Vol. 6/Issue 2. Copyright 2009 by Nature Publishing Group. Reprinted by permission of Nature Publishing Group via the Copyright Clearance Center.

Select one of the following articles on psychodynamic therapy to evaluate in your Assignment:

Aznar-Martinez, B., Perez-Testor, C., Davins, M., & Aramburu, I. (2016). Couple psychoanalytic psychotherapy as the treatment of choice: Indications, challenges, and benefits. Psychoanalytic Psychology, 33(1), 1–20. doi:10.1037/a0038503

Karbelnig, A. M. (2016). “The analyst is present”: Viewing the psychoanalytic process as performance art. Psychoanalytic Psychology, 33(supplement 1), S153–S172. doi:10.1037/a0037332

LaMothe, R. (2015). A future project of psychoanalytic psychotherapy: Revisiting the debate between classical/commitment and analytic therapies. Psychoanalytic Psychology, 32(2), 334–351. doi:10.1037/a0035982

Migone, P. (2013). Psychoanalysis on the Internet: A discussion of its theoretical implications for both online and offline therapeutic technique. Psychoanalytic Psychology, 30(2), 281–299. doi:10.1037/a0031507

Tummala-Narra, P. (2013). Psychoanalytic applications in a diverse society. Psychoanalytic Psychology, 30(3), 471–487. doi:10.1037/a0031375

PSYCHOANALYSIS ON THE INTERNET

:
A Discussion of its Theoretical Implications for
Both Online and Offline Therapeutic Technique

Paolo Migone, MD
Psicoterapia e Scienze Umane, Parma, Italy

Psychoanalysis over the Internet is discussed as a means of reflecting on the way
we think about theory of technique generally, and on what we mean by
“communication” between patient and analyst. The way we think about online
therapy has direct implications for the way we practice “offline” therapy. This
problem is discussed from the point of view of the history of the theory of
psychoanalytic technique, with reference to the classic 1953 paper by Kurt
Eissler (K. R. Eissler, 1953, The effect of the structure of the ego on psycho-
analytic technique, Journal of the American Psychoanalytic Association, Vol. 1,
pp. 104 –143) on “parameters,” and also with reference to the redefinition of
psychoanalysis itself in terms of the analysis of the transference by the late
Merton Gill (e.g., M. M. Gill, 1984, Psychoanalysis and psychotherapy: A
revision, International Review of Psychoanalysis, Vol. 11, pp. 161–179). Online
therapy is simply a different therapy, in the same way as two therapies, both
offline (or both online), may be different from each other. The fil rouge that runs
through this paper is a reflection on the very identity of psychoanalysis.

Keywords: Internet psychotherapy, Internet psychoanalysis, online psychother-
apy, theory of psychoanalytic technique, parameters of psychoanalytic
technique

It is a commonplace to say that the Internet is changing the way we communicate, and also
the way we live, with repercussions that are not easily foreseeable. The worldwide web
(www) is penetrating into every corner of our life, gradually changing ourselves and itself
as it becomes more and more sophisticated in order to meet the most diversified needs.
The importance of the Internet has been compared to the revolutionary discovery of the
printing press.

Here I will take into consideration only one of the many possibilities the Internet can
offer, namely as a vehicle for psychoanalytic therapy. But this paper will not deal with the

The author thanks Morris N. Eagle and John Kerr for their help in revising this paper.
Correspondence concerning this article should be addressed to Paolo Migone, MD, Via

Palestro 14, 43123 Parma, Italy. E-mail: migone@unipr.it

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Psychoanalytic Psychology © 2013 American Psychological Association
2013, Vol. 30, No. 2,

281

–299 0736-9735/13/$12.00 DOI: 10.1037/a0031507

281

mailto:migone@unipr.it

http://dx.doi.org/10.1037/a0031507

clinical aspects of Internet therapy (a literature already exists in this regard). It will deal,
instead, specifically with the theoretical implications of both online and offline therapy for
therapeutic technique, and in order to do so it will necessarily discuss also the differences
between the two therapeutic settings. It is argued that the way we think about online
therapy has direct implications for the way we think and practice traditional, “offline”
therapy. In other words, this paper will not deal with the question of therapeutic action or
with the validity of online therapy. Internet therapy is only taken as a pretext—an excuse,
so to speak—in order to reflect on theory of psychoanalytic technique in general, and also
on the identity of psychoanalysis versus psychoanalytic psychotherapy. It should be clear
that this paper is not a plea for the practice of psychoanalysis online. Rather, it aims at
encouraging a reflection on theory of technique. Psychoanalysis on the Internet is not
discussed as such in this paper, but serves as a reference point to consider theory of
technique, in particular the way we conceive “communication” between patient and
analyst.

Psychotherapy on the Internet has been referred to in many ways; for example, as
online psychotherapy, telepsychotherapy, e-psychotherapy, etc., and it is a phenomenon
that is rapidly growing. There are more and more web sites for counseling or for online
psychotherapy, studies on the efficacy of this practice have been carried out, and so forth.
In recent years, several psychoanalysts involved with the China American Psychoanalytic
Alliance (CAPA, http://www.capachina.org) are experimenting with teaching, supervi-
sion, and therapy with Skype to Chinese colleagues with the aim of helping the growth of
psychoanalytic practice and culture in that country. (For discussions on the psychological
implications of the Internet and on the interface between the Internet and psychoanalysis,
see, among others, Turkle, 1985, 1995; Wallace, 1999; Bird, 2003; Akhtar, 2004; Ormay,
2006; Malater, 2007; Monder, Toronto, & Aislie, 2007; Dini, 2009; Cairo & Fischbein,
2010; Scharff, 2012; see also “Special issue on the Internet,” 2007, Vol. 94, Issue 1, The
Psychoanalytic Review).

Technical Aspects of Internet Communication

The Internet allows us to connect and communicate with people who may live in any
corner of the world at a very low cost, virtually for free, or, at worst, at the price of a local
phone call. One may object that this happenstance is not altogether new, since the
telephone already made this possible. In fact, in the United States the issue of “telephone
analysis” was discussed at least as early as the 1950s (e.g., Saul, 1951). Commentators
have variously considered telephone analysis a useful way to overcome certain resistances
or impasses in the analysis, to replace missed sessions, to save time and reduce travel
expenses in the case of long distances or when a patient’s handicaps limit movement, and
when either patient or analyst move to another city and the parties do not want to interrupt
an ongoing analysis.

What the Internet can offer, compared to the telephone, is the opportunity for a
video-conference (e.g., with Skype). Thanks to so-called virtual reality, it is possible to
simulate the session almost exactly. There are those who even simulate the waiting room.
With audio and video synchronized in real time, it is possible also to duplicate the timing
of interventions, silences, the length and times of scheduled “sessions,” and various other
rituals as if both partners were in the office. Concerning privacy, sophisticated programs
(such as those used by Internet banks) may encrypt communications (this is true especially

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282 MIGONE

http://www.capachina.org

with Skype, considered to be secure in computer-to-computer communications1), and
ethical codes for Internet have been suggested (e.g., see American Psychological Asso-
ciation, 1997; Manhal-Baugus, 2001; Heinlen, Welfel, Richmond, & O’Donnell, 2003;
Mora, Nevid, & Chaplin, 2008; Fitzgerald, Hunter, Hadjistavropoulos, & Koocher, 2010).
Nonetheless, in many respects, Internet psychotherapy can be considered a variation of
telepsychiatry or even telemedicine, both of which have been experimented with for a
number of years in order to reduce costs in countries such as Australia, where there are
often formidable distances intervening between doctors and patients (e.g., see Dongier,
1986; Preston, Brown, & Hartley, 1992; Baer et al., 1995; Kaplan, 1997, 2000; Brown,
1998; Gammon, Sorlie, Bergvik, & Hoifodt, 1998; Gelber & Alexander, 1999; Zaylor,
1999; Simpson, 2001; Taylor & Luce, 2003; Hilty, Marks, Urness, Yellowlees, & Nesbitt,
2004; Bauer, Wolf, Haug, & Kordy, 2011; Wolf, 2011).

Video-conferencing (e.g., with Skype, which is widely used) is not the only way of
Internet communication; there are other modalities that are quite different. These modal-
ities are distributed along a continuum of types of human communications, and they
should not be lumped together, because each has its own specific characteristics that shape
the therapeutic interaction—in the same way as, for that matter, various “normal,” offline
therapeutic situations have their own characteristics that shape the interaction. For
example, another possibility for therapeutic interchange is constituted by the written
communications of e-mail or chat (the latter is in real time). Actually, these forms of
written communication seem to be more widely used as methods for Internet therapy or
counseling, perhaps because they do not require any special technical arrangements
beyond an ordinary personal computer (incidentally, we should not forget the widespread
use of SMS [short message service] with cellular phones between patients and analysts).
Other commonly used modalities are discussion lists, forums, and blogs or self-help
groups, where—in a way analogous to groups such as, for example, Alcoholic Anony-
mous—more people can interact and talk about common themes, or else can simply listen
(“lurk”) and profit from what others say (for an overview, see Houston, Cooper, & Ford,
2002).

It may be worthwhile to spend a few moments on the differences between written and
oral communication before proceeding (Migone, 1998b). The enormous diffusion of
communication by e-mail may represent a veritable return to the era of correspondence
through letters, an era which had disappeared with the advent of telephone. But upon
reflection, e-mail is similar to hand-written letters chiefly in one respect; namely, the fact
that one has to write down what one wants to say, inducing, due to the slowness of the
process, a different emotional and reflexive disposition. To be sure, this putative slowness
is true especially of hand-written letters, as writing with a keyboard is invariably much
faster. Moreover, thanks to word processing, the process has been speeded up further, for

1 According to the Handbook of China American Psychoanalytic Alliance (CAPA), “Skype is
encrypted using a proprietary code that has never been released by the developers, despite
substantial pressure on the part of many powerful public entities. . . . It is nearly impossible to detect
not only the contents of the conversations, but also their existence. . . . Apparently, Skype is so safe
that criminals can speak using it, and the police cannot listen in—and this is Interpol, not just some
local cops. Skype has been able to reject court orders to decrypt, because its central offices are in
Luxembourg, and thus protected from the EU confidentiality laws (Skype was developed in Latvia).
However, . . . all the comments on security discussed above apply to the computer-to-computer
communications. The paid features of Skype and texting—are not secure» (Buckner, 2011, p. 13,
italics in the original text).

283PSYCHOANALYSIS ON THE INTERNET

it is now also possible to review the text and erase “errors” or simply to delete text with
great rapidity. To be sure, it was always possible to recopy a letter with changes or even
tear it into pieces and throw it into the wastebasket, with the option of retrying it on
another day. Yet editorial changes on written letters generally take more time.

An important difference between e-mail and surface mail (“snail mail”) is the trans-
mission speed, which is close to real time with e-mails (they can reach their destination
within seconds or minutes) and very slow for surface mail (days). This arguably creates
a sense of immediacy in sending an e-mail that a regular letter— even if it is by special
post—lacks. But this immediacy is offset by the fact that with e-mail it is difficult or
impossible to communicate other meanings except the content itself, which is privileged
at the expense of nonverbal or analogical communication. Not only it is impossible to see
the facial expressions and to hear the tone of voice, as in face-to-face contact, but it is
clearly impossible in e-mail to see personal calligraphy, except for the style allowed by
word processing; namely, choice of font, capital letters (as in screaming), italics, bold (in
programs that allow this), and “emoticons” (a well known term that means emotions
symbolized by icons, e.g., using parenthesis for the mouth, colons for the eyes, etc.).
Whether for these reasons, or due to the sense of immediacy of nearly real-time commu-
nication, or because of a vague ancestral tie to that forerunner of all e-mails—the
memo—people do not ordinarily put into their e-mails anything like the concentration,
circumspection, or art they once put into their letters. That is not to say they couldn’t if
they chose. And to this must be added the pertinent comparison that people have never put
the same level of concentration or art into their conversation— except in diplomatic
situations and in salons, where it is expected. Yet this lack of art in conversation obviously
does not prevent psychotherapy from taking place, any more than letter writing necessarily
either enhances it or prevents it. For the record, the first historical example of “psycho-
analysis by letters” could be considered the correspondence between Freud and Fliess, as
several historians of psychoanalysis have pointed out.

Why Is Psychoanalysis on the Internet Interesting?

In the introduction above, I have discussed the technical aspects of various ways of
Internet communication, and it should be repeated that they are quite different from each
other, since each one has its own peculiarities that shape the interaction. Let’s focus now
specifically on psychoanalysis on the Internet, and let us ask why it might be interesting.
In this regard, I want to make clear, as I emphasized before, that I am not fundamentally
interested in online analysis per se, even though in some cases I have practiced it, as have
others. What has always been of great interest to me, indeed has been fascinating to me,
is the way some colleagues have faced and discussed the issue of online psychoanalysis,
how they have addressed themselves to this “new” object, and especially their way of
seeing similarities and differences with “traditional” (i.e., offline) psychoanalysis. I have
been particularly intrigued by their claims to be either in favor or against online psycho-
analysis and their reasoning. What has fascinated me was the logic behind this endorse-
ment or disavowal as the case may be.

In my view, online psychoanalysis is interesting because it forces us to reflect on what
it is not; that is, traditional psychoanalysis. The way online psychoanalysis is discussed is
revealing of the way psychoanalysis without Internet could be conceived and practiced,
and especially of what we mean by “communication” between patient and analyst. In
particular, I will try to show in detail the danger of relying on a stereotyped understanding

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of the technique of traditional therapy, at times virtually a ritualized one, in which the link
between theory and technique could be lost. I want to make clear that I am not criticizing
the actual practice of some colleagues; I am criticizing only a possible way of conceiving
theory of technique. In fact, a stereotyped understanding of technique would seem to
inevitably lead to errors in the conduct also of offline therapy.2

This, then, is the source of my interest in Internet therapy. In particular, it was during
an animated discussion I had in 1998 in a forum by e-mail with the editorial board of an
online professional journal with which I was involved at the time that I was struck by the
difficulty some colleagues had in fashioning a thoughtful approach to this issue. It was
then that I realized that the problem lay not in developing a theory of online therapy per
se, but in a failure to clarify the underlying understanding of the theory of technique itself.
That is, the difficulty these colleagues experienced would have arisen in facing any
situation that deviated from “normal” therapy; it was as if the technique of normal therapy
had been learned as a ritualized procedure without consideration of the underlying
implications.

There is not a separate theoretical arena for Internet therapy any more than there is a
separate arena for those therapies practiced in other kinds of “heterodox” situations. In
recent decades, new frontiers and the “widening scope” (L. Stone, 1954, p. 567) of
psychoanalytic intervention have tested the inner consistency of the so-called “basic
model of psychoanalytic technique” (Eissler, 1953, p. 108), or “classical technique” as it
historically developed. This testing of our technique is still encountered in daily, routine
work, whenever the patient—labeled for example as “borderline”—succeeds in challeng-
ing or confusing an analyst armed with the best intentions. Some mistaken ways of
conceiving therapeutic work may never come to light if the analyst relies on traditional
clinical practice and has an untaxing patient population. But they immediately become
evident as soon as the analyst has to face a new situation with a different type of patient.
I believe these problems derive from the way theory of technique was transmitted in some
psychoanalytic circles in the past, and at times we may still see its remnants today.

More than 60 years ago Leon Saul (1951), the first analyst I know of to ponder the use
of the telephone in psychoanalysis, addressed the underlying point in The Psychoanalytic
Quarterly:

All thinking is restricted by inertia. We think as we were taught to think. New ideas, attitudes,
and approaches always encounter resistance. This is especially true in psychoanalysis, where
because the personal analysis mobilizes the unconscious submissiveness to the parents, and
the narcissistic identification with them, the teacher’s authority tends to be unusually great,
and carries with it special obligation to impart a truly academic and scientific outlook. This
is an ironic quirk in a science born of one man’s devotion to reality despite the weight of all
sorts of authority.
In view of these considerations, one wonders if the idea of using modern technology in the
form of the telephone, as an adjunct to psychoanalytic technique, will be met with horrified
resistance, or whether most analysts are already far ahead of this in their thinking and
anticipate experimenting with televisual communication if and when this becomes practicable
(Saul, 1951, p. 287).

2 In another paper (Migone, 2009), I have utilized the same approach to so called “brief
therapy,” which provides the opportunity for reflecting on wider problems pertaining to both “brief”
and “long-term” therapy and to the theory of technique of psychotherapy in general.

285PSYCHOANALYSIS ON THE INTERNET

These words sound prophetic. Prophetic, too, was Saul’s summary judgment: “Every
technical procedure is only a means to an end, and its use must depend upon the basis of
the rationale of all treatment: psychoanalytic accuracy in understanding the patient” (p.
290). In the paper Saul discussed, among other things, the usefulness of using the phone
with a patient who at the moment was unable to handle her emotions during sessions.
However, he realized that over the phone—for reasons too complicated to discuss
here—she was able to talk about specific transferential issues, making possible their
working through and the subsequent resumption of regular sessions. The use of telephone,
in this case, perfectly satisfied the criteria that 2 years later Kurt Eissler (1953) introduced
as a way of systematizing in a coherent way the introduction of modifications of “basic
model technique” which he called parameters.

And it is with Eissler’s conceptualization that I want to anchor my reflections on
Internet therapy. I am well aware that Eissler’s (1953) conceptualization of “parameters
of technique” is generally considered outdated in contemporary psychoanalysis, but—as
I will try to show in this paper—I am convinced that it is often misunderstood, and it
should remain an unavoidable point of reference within the debate on theory of technique.
It is generally recognized that today theory of technique is more a subject of debate rather
than of consensus, but in order to have a debate we need to have positions to be confronted
with each other, and my paper represents just one of these positions.

Could Internet Be Considered a “Parameter” of Technique?

I am obliged to begin by noting at the outset that Eissler himself was against the idea of
an online psychoanalysis, at least as it could be conceived of 30 years ago. At a meeting
held at Cornell Medical Center in New York on the occasion of the 30th anniversary of
his classic 1953 paper on parameter, I heard him say that one might argue that maybe there
was some truth in the criticisms some had leveled against his concept of parameter, to the
extent that nobody ever succeeded in conducting an analysis with the computer or by
passing over to the patient interpretations written on pieces of paper. The implication,
perhaps, was that there were limits to how austere an analysis could be. What this implies
for the current discussion I will take up shortly.

First, we need to spend a few words on that classic paper itself, since, as I said, I am
convinced that it is often misunderstood. I will try to show that Eissler’s concept of
parameter cannot be easily dismissed, because it still has important implications for the
identity of psychoanalysis. As is well known, Eissler’s 1953 paper was written in the mid
20th century in an historical period marked by a great expansion of psychoanalysis within
the U.S. as more and more patients sought psychoanalytic treatment, including some with
diagnoses indicative of severe psychopathology. Very soon analysts realized that classic
technique could not be applied to all such patients, and that modifications were necessary
depending on the severity of the diagnostic condition. Classical technique, in fact, was
based on a privileged use of verbal interpretation, with the virtual elimination of all other
“spurious” factors such as reassurances, advice, variations of length and number of weekly
sessions, and so forth. The analyst was supposed to stay as neutral as possible, to remain
a blank screen, sitting behind the couch in order to minimize his influence on the patient,
and limiting himself to verbal interpretations that were conceived as psychoanalysis’
mutative factor par excellence. It is in this context that Eissler’s paper has to be
understood.

286 MIGONE

In his paper, Eissler systematized the problem of pragmatically indispensable modi-
fications of technique in the light of the theoretical implications of ego psychology (at the
time the dominant theory in North American psychoanalysis); that is, of the felt need of
taking into greater consideration the points of view of adaptation and defense. He called
a “parameter” any change in basic model technique (which was defined with “zero”
parameters), and suggested that a technique could be still called psychoanalysis if the
introduction of a parameter was based on the following four criteria: 1) it should be
introduced only when there is evidence that the standard technique is not sufficient (that
is, when there is an ego deficit that does not allow the patient to tolerate basic model
technique); 2) it should never go beyond an inevitable minimum; 3) it should be
eliminated before the end of analysis; 4) its repercussions on the transference should never
be so great that they cannot be worked through and eliminated with interpretation (see
Migone, 2010, pp. 69 –70).

Thus Eissler reasserted the value of basic model technique, which can never be
reached in reality, as he was well aware, but remains useful as an heuristic goal, while
accepting the use of parameters on the conditions that they could be reduced to a minimum
and worked through with interpretation (which would be evidence of structural change
and thus indicative of the repair of the ego deficit that had required the parameter’s
introduction in the first place). In other words, this conception of psychoanalysis relies on
the role of interpretation, which is strictly linked to a specific ego structure, while it is well
known that contemporary psychoanalysis relies on a much wider conception of treatment
seen as a wide ranging and diversified set of interventions. Behind this statement, of
course, there are important and often debated issues concerning the identity of psycho-
analysis itself.3 In fact, one might arguably say that some “psychoanalytic” theories or
techniques— especially today—are identical to some “psychotherapeutic” theories or
techniques. However, many discussions on the identity of psychoanalysis (and especially
of the “psychoanalysts”) often confuse theoretical with political issues; that is, the need to
clarify our position and to discuss them in depth should not be inhibited by the (often
fantasized) threat of exclusion from the psychoanalytic movement (to this regard, see
Migone, 2011).

We all know that psychoanalysis today is practiced in a very different way from the
classical, mid-20th-century technique, but curiously this “new” technique can be ex-
plained in different ways according to which theory we use. For example, Eissler himself,
who is still considered by many as the champion of old fashioned classical technique, was
extremely flexible with his patients, to the point that his technique to some extent could
resemble a form of “contemporary” psychoanalysis. A recent article by Emanuel Garcia
(2009), Eissler’s literary executor, describes in detail his technique, and it is impressive to
see how Eissler was flexible, free, and able to intervene according to his patients’ needs
while simultaneously maintaining a psychoanalytic stance (one might argue that the same
could be said of Freud’s technique, with the important difference that they had another
rationale: Freud was trying to do everything he could in order to recover memories of
traumatic events, while Eissler was trying to do everything he could also in order to
respect the patients’ defenses). What I mean is that there is nothing wrong in having a

3 As a recent example of such debates, see the four critical Letters to the Editor (by Lewis Aron,
2010; Yoram Hazan, 2010; Emanuel Berman, 2010; and Steven Stern, 2010), stirred by Rachel
Blass’ (2010a) paper titled “Affirming ‘That’s not psycho-analysis!’: On the value of the politically
incorrect act of attempting to define the limits of our field” (see also Blass’ [2010b] reply and my
comment [Migone, 2011]).

287PSYCHOANALYSIS ON THE INTERNET

flexible technique and improving our therapeutic potential, but the theoretical problem
remains: how do we differentiate psychoanalysis from psychoanalytic psychotherapy (this
in fact was the main goal of Eissler’s paper) or from one of the many types of experiential
therapies? (i.e., based on corrective experiences, without an attempt at uncovering un-
conscious content or clarifying meanings). I think that Eissler tried to give a reply to this
question; that is, he defined on the conceptual level what could be properly called
psychoanalysis. As I said, this is often perceived as a hot issue because many colleagues
fear that these theoretical discussions imply a threat of exclusion from the psychoanalytic
movement. But this is a big misunderstanding of the relationship between theory and
technique. In fact an implication of a correct understanding of this discussion is that—in
Eissler’s terms—in order to perform a correct psychoanalytic technique one has to be
flexible (i.e., perform what could be defined a “psychotherapy” from the descriptive point
of view), otherwise he would not be a psychoanalyst (a strict adherence to a psychoan-
alytic technique with a patient who cannot tolerate it would be a technical error). And even
if, for the entire course of the treatment, it would be impossible to eliminate—in Eissler’s
terminology—the parameters before the end of analysis (i.e., even if it would remain a
“psychotherapy”), still the therapist would be employing psychoanalytic technique and
theory (i.e., he would remain a “psychoanalyst”).

It is becoming more clear now why I am pivoting these reflections on Internet
psychoanalysis on Eissler’s concept of parameter. But there are other reasons why
Eissler’s concept of parameter is interesting in this regard: Ironically, and contrary to the
skepticism of many analysts toward therapy over the Internet, it would seem that an online
psychoanalysis, based only on the “impersonal” communication between therapist and
patient, could satisfy the comparatively austere criteria for classical psychoanalysis, seen
by many as “deeper” and more therapeutic than other therapies! For on the Internet the
mutative ingredient, verbal interpretation, remains in place. Nor are other aspects of the
classical treatment set-up altered (neutrality, a blank screen, analyst out of sight, etc.).
Actually, in all these respects, we could say that e-mail therapy mimics classical psycho-
analysis.

How are we to understand this surprising resemblance? A full discussion would entail
a detailed evaluation of the history of theory of psychoanalytic technique over the last
century. Here I can make only brief comments (for further discussion, see Migone, 1991,
1994a, 1995, 1998a, 2000, 2001, 2003, 2010 chapters 1 and 4). To begin with, the current
cautiousness about endorsing Internet therapy can perhaps partly be explained by refer-
ence to the fact that recent decades have witnessed growing criticism within the psycho-
analytic movement, amounting to almost a complete rejection, of the conceptions of the
classical model insofar as they were based on the therapist’s anonymity. That is based on
what I once called, borrowing a medical metaphor, the analyst’s “personectomy” (Migone,
1994b, p. 130; 2004, p. 151). As Kernberg (2011), among others, has argued, this
development is possibly due to the fact that often “anonymity” has been confused with
“neutrality,” and it could also be “a product . . . of the authoritarian structure of psycho-
analytic ego psychological and Kleinian institutions in the 1940s and 1950s” (p. 656). It
is precisely that personectomized model that would seem to be exemplified in an extreme
form, indeed to the point of caricature, by Internet therapy. Yet herein also lies an
opportunity: The diffusion of Internet therapy, among other things, by reopening this
problem within the debate on psychoanalytic technique, gives us the opportunity to
reexamine these issues of theory of technique.

Following Eissler’s argument, a therapy with parameters (i.e., modifications of the
rules according to the patient’s needs, with interventions by the therapist who in a complex

288 MIGONE

way modulates the classical model technique) is indicated for those patients who, due to
their ego deficits, are unable to tolerate a model of technique based only on interpretations.
Should we deduce, then, that Internet therapy, with its reliance on verbal interpretation, is
indicated for those patients who have an intact ego (who, by the way, are extremely rare)
or that have milder forms of psychopathology? I think this is not the way to set the
problem, the issue being more complicated. But please note, however, the apparent
paradox: On the face of things, Internet therapy would seem to be indicated for healthier
patients, who could benefit from a restricted diet of verbal interpretations alone. Then
again, for different reasons, it would also seem indicated for sicker patients; that is, those
who are afraid of emotional closeness or overinvolvement with the therapist (such as
Saul’s [1951] patient mentioned earlier who used the telephone for a period of time).

Incidentally, in this context it is not compelling to argue that today, thanks to the
possibilities offered by the multimedia communication, “virtual” therapy does not need
separate justification given the extent to which it can simulate “real” therapy. I do not
recall the further details of Eissler’s discussion in his talk as to the possibilities of
psychoanalysis with the computer, but I think that if skepticism toward Internet therapy
was once understandable, technological advances do not of themselves provide sufficient
reason to be less skeptical and to think that Internet therapy can be indicated for either
healthier or sicker patients. But in any event this is not the way, in my opinion, that we
should be thinking about the problem. The issue is not whether it is possible or not to
simulate with “virtual” reality (today possible over the Internet) the “real” reality of the
patient�therapist interaction, with the latter being held up as a model or an ideal which
we should try to approximate as closely as we can. The problem needs to be stated
differently; namely, by reflecting on the theoretical premises inherent in Eissler’s con-
ceptualization of “classic” technique, the very premises that have themselves lately been
viewed critically in many psychoanalytic circles.

Eissler’s reasoning had a high degree of inner coherence, and his 1953 paper is still
valid regarding the role of the analytic frame in the logical structure of psychoanalytic
interpretation (in this regard, see Codignola’s [1977] important contribution on—I quote
his book’s subtitle—the “logical structure of psychoanalytic interpretation”). In his paper
Eissler wanted to deal with the important issue of the relationship between words and
action in analysis, and the role of mentalization, as we might now call it, as a guarantee
of the patient’s autonomy from the environment; that is, from the parameter that was
introduced in order to help him reestablish his psychological equilibrium. On such an
opportunity hangs the possibility of psychoanalytic change, that is, structural change. In
fact, a parameter (such as a reassurance, an action, or a corrective experience) is
introduced just because interpretation does not work, and it takes the place of interpre-
tation, so to speak. In Eissler’s words, it is necessary because of an “ego deficit” (e.g., the
inability to understand the meaning of a symptom), so that only a behavior (the parameter)
and not words (interpretation) can help the patient. When the patient is able to use
interpretation (i.e., to mentalize), the parameter can be eliminated and it is possible to go
back to the “basic model technique.” Incidentally, it must be clear that, according to this
line of argument, if Internet can be a “parameter” of technique, the reverse could also be
true; namely that non-Internet therapy can be a parameter of Internet therapy if the latter
is the treatment set for a given patient. For example, an Internet therapy patient might
temporarily need to be reassured with one or more vis-à-vis sessions if he is going through
specific difficulties that, for various reasons, cannot be worked through within the online
setting, so that the analyst decides to introduce a parameter that in this case consists of

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traditional, offline therapy.4 This possibility may appear paradoxical, but is totally coher-
ent with the concept of parameter if one is able to understand what Eissler was trying to
say regarding theory of technique and the logical structure of interpretation (see, to this
regard, Codignola, 1977).

The aspect of Eissler’s conceptualization that more directly concerns us here, how-
ever, and that has come to be seen in a very different light in recent years, involves what
he called “basic model technique.” Embedded in his description of basic model technique
was the idea that only one kind of technique, the classic one, in which the analyst sat out
of sight and was careful not to intrude his own personality in any way, is good for evoking
the transference. Tightly linked to this premise was the further notion that this kind of
model, with the analyst endeavoring to provide only a “blank screen,” guarantees a “pure
and uncontaminated” transference, and a truly free association; that is, uncontaminated by
the analyst’s influence. As argued in later years by several authors (in primis Gill [1982,
1983, 1984, 1994], who in his own way reevaluated and reinstituted the intuitions of
Sullivan and other interpersonalist authors dating back to the 1920s and 1930s), this faith
in the analyst’s effective nonbeing could be highly naïve. Indeed, this faith can lead to the
analyst’s having an increased influence on the patient precisely because it is not analyzed
(in fact it is not considered to exist; see Migone, 2000; Green, Kernberg, & Migone, 2009,
pp. 219 –221).

Here let us examine for a moment—and only as one of the many examples of a way
of reasoning around the meaning of a given psychoanalytic frame—Gill’s critique of
Macalpine’s (1950) earlier conception of psychoanalysis as an “infantile setting.” Ma-
calpine had argued that, as an “infantile setting,” classical analysis would be apt to evoke
just that kind of transference which we want to analyze. She defined the “infantile setting”
in terms of the regular frequency of sessions, the use of the couch, a stable, unchanging
environment, and so forth; that is, the very model of technique that Eissler would
subsequently talk about in his paper. But Gill (1984, pp. 169 –170) pointed out a
contradiction in this regard: If transference is conceived as spontaneous and “uncontam-
inated” by the present situation, why then would we need specific measures (such as the
couch, a stable, unchanging environment, etc.) in order to provoke it? In other words, why
would we need to “manipulate” it by providing an “infantile setting”? The transference
that now appears would not be a repetition of the past enacted in front of an analyst who
remained a blank screen, but simply a more or less expectable reaction to that “infantile
setting.” It would be an “infantile transference,” or, alternatively, a “classic transference”
evoked by a “classic frame,” only in the sense of an iatrogenic reaction conceptually
similar to hypnosis, which is the contrary of psychoanalysis. Very beautiful are the pages
in Gill’s critique in which—pace the orthodox analytic view— he shows how a classical
analysis could in effect be a “manipulatory psychotherapy,” while a once-a-week and
vis-à-vis therapy in which the transference is carefully analyzed could be a “psychoanal-
ysis” in every respect.

Obviously, or perhaps not so obviously, Gill’s demolition is not meant to be a critique
of the ground rules of classical psychoanalysis—which are rules like any other, neither
better nor worse— but a critique of the idea that any given frame, any given set of rules,

4 In a similar vein, elsewhere (Migone, 2000) I described the clinical case of a patient who,
during a vis-à-vis therapy, had to lay on the couch for a few sessions in order to overcome specific
transferential difficulties originated by the vis-à-vis setting. That intervention was conceptualized
and worked through as a typical parameter in Eissler’s (1953) sense; the seemingly paradoxical title
of that paper was “A psychoanalysis on the chair and a psychotherapy on the couch.”

290 MIGONE

guarantees the analyst’s lack of influence on the transference, and that only those rules
should be used for every patient in all cultures and historical periods. In point of fact, the
latter stipulation is indeed the underlying implication of how psychoanalysis exists
institutionally, otherwise we would not have the International Psychoanalytic Association
setting standards such as the use of the couch and a schedule of four times a week as the
desired frequency (even if we all know that these rules are followed more in theory than
in practice, and that changes in these rules are under way).

The inability of the “classic” rules to guarantee an uncontaminated transference across
the board necessitates an alteration in how we understand the analysis of transference.
This is why—according to Gill—the classical rules are not justified any more, so that he
proceeds to do away altogether with “extrinsic criteria” (couch, frequency, etc.), while
redefining “intrinsic criteria” (he centers them only on the analysis of transference) and
espousing a radical and enlarged definition of psychoanalysis which is applicable in the
most diverse settings, including once-a-week therapy or therapy with variable frequency,
groups, emergency consultations, brief therapies, treatment of patients with more severe
diagnoses and/or on medication. What is important is that the analyst always does his best
to analyze the transference. This is the only intrinsic criterion Gill saved, and it could
perhaps better be defined as “analysis of the relationship,” since Gill conceived it in a
“relativistic” or “perspectival” way, that is as an analysis of the patient�therapist
interaction, which is always influenced by the setting, whatever it is.

Thus, it would be a mistake to argue that the classic model is inferior to another model;
for example, without a couch, or with a lower frequency per week, or, for that matter, even
over the Internet. The classic model is a model like any other; it will only evoke its own
type of “contamination” of the transference. Every patient, in fact, will react to a given
setting not according to some ideal model we think is valid for every patient, but in his
or her own idiosyncratic way since it is the transference itself, based on the patient’s past
experiences, that will determine how the setting will be perceived by the patient. As a very
simplistic example, if a patient had quite reserved and silent parents perhaps he will be at
ease with an “orthodox” analyst, while a different patient with parents who were very
warm and exuberant might perceive this same analyst as cold or detached. It is obvious
that it would be wrong to see as transference only the latter’s reaction and consider as
“normal” (i.e., nontransferential) the nonconflictual state the first patient is in when he is
with a silent and reserved analyst. Indeed his apparently “normal” reaction with an
“orthodox” analyst would not allow us to shed light on this important area of the patient’s
functioning, which, however, would likely become more visible if he were to be exposed
to a different setting with the result that it could then be analyzed (for a discussion of
Gill’s ideas, see Migone, 1991, pp. 71, 2000, 2005, 2010, pp. 71–79; Green, Kernberg, &
Migone, 2009, pp. 216 –221). The allusion to Internet therapy here is obvious, because
transference configurations might appear that would never appear in other settings (and
this is true, of course, for any setting).

It may be clear at this point why I wanted to pivot my reflections on Internet
psychotherapy on a review of Eissler’s concept of parameter together with Gill’s position
on intrinsic and extrinsic criteria for defining psychoanalysis. If we accept that there is no
longer any “gold standard” for psychoanalysis in terms of extrinsic criteria, it logically
follows that we can also conduct an analysis on the Internet (however, as I stated earlier,
the aim if my paper is not to show the legitimacy of psychoanalysis on the Internet, which
is only an implication of a more general discussion on theory of technique and on the
identity of psychoanalysis; in other words, it would be a misunderstanding to conclude,
simplistically, that this paper is “in favor of psychoanalysis on the Internet”). What is

291PSYCHOANALYSIS ON THE INTERNET

important is the careful analysis of the transference manifestations according to the
context in which the patient�therapist interaction occurs, in this instance on the Internet
in all its variations. We must simply proceed with the awareness that this context, like any
other context, will always have an important influence on the transference and on the
countertransference as well.

Further Considerations

In order to avoid possible misunderstandings, some further clarifications are necessary.
Specifically, it is important to analyze some of the implications underlying the argument
that has been made to the effect we should not exclude Internet therapy a priori. Many
colleagues have a summarily critical and even dismissive attitude toward Internet therapy.
Such a reaction is understandable if we think of its possible abuses in terms of fostering
“wild analysis” or its indiscriminate use as a substitute for traditional therapy. Actually,
the logic of why Internet therapy should selectively be abused is not clear, since many
therapists might find it more difficult and the format itself is less remunerative. Perhaps
it may be abused in this first, pioneering phase as some exploit this new modality to search
for patients that cannot so readily be reached and enrolled in treatment in other ways. But
soon this territory will be overpopulated and the “first come, first served” rule will no
longer apply. In which case qualified practitioners will crowd out less able ones to more
or less the same extent they do now. I do think that we should be critical of Internet
therapy but only to the extent that we are equally critical of traditional therapy, which is
equally prone to being abused and practiced in a “wild” fashion. What I think should be
emphasized is that a critical attitude toward Internet therapy on a priori grounds can hide
a permissive attitude toward traditional therapy. Moreover, such an a priori rejection may
involve the incorrect assumption that the external criteria of psychoanalysis are the
determining factors (this issue, of course, has to do with the identity of psychoanalysis).
To the contrary, it is the meaning of the whole experience that characterizes therapy
(including the interplay between extrinsic and intrinsic criteria).

This gives us the opportunity to reflect on what we mean by “communication”
between patient and analyst. Communication refers to the meanings that are transmitted,
and this transmission can occur in many different ways, not only in person or during live
interactions such as in the traditional psychoanalytic situation. As we well know, at times
a half word by telephone (or, for that matter, over the Internet, even with an e-mail or an
sms) may have more powerful effects than a detailed communication during a session. The
common idea that communication between patient and analyst ideally should occur during
a traditional psychoanalytic session might hide a misunderstanding of the relationship
between extrinsic and intrinsic criteria of psychoanalysis. In fact, the privileging of
extrinsic criteria cannot but lead to technical errors also within traditional, non-Internet
psychoanalysis. In this regard, examples are innumerable. Let us think only of the couch:
Those who are against the therapeutic use of Internet may be the same (actually, often are
the same) who believe that the couch (or any other element of the setting, for that matter)
is essential for psychoanalysis, when in itself the couch is irrelevant (what is relevant is
the patient’s reaction to the couch, as well as to the chair or to any other aspect of the
ground rules; see Migone, 1998a, 2000). This stereotyped reasoning, as Galli (1988, 1990,
2002, 2006) has argued convincingly, brings with it a reification of technique, as if, so to
speak, technique could itself become “theory.”

292 MIGONE

Internet psychotherapy would appear to be particularly useful not only when there is
a great geographical distance between patient and therapist, but also when it is used in
ways that are consonant with Eissler’s conceptualization of a parameter. That is, it may be
indicated in those cases (typical examples are schizoid personality, agoraphobia, or social
phobia) when the patient is unable to face the personal contact with the therapist while he
is able to open up at a certain emotional distance that is being symbolized by physical
distance (there thus being an “ego deficit” in Eissler’s terms). The patient might well be
engaged in an initial phase of treatment in this way if, for example, he initially asks for
help on the Internet or by e-mail; then after his resistances are worked through he might
be able to continue with traditional psychotherapy if this is the modality deemed appro-
priate. Of course, also the opposite could occur; a patient might begin with traditional
psychotherapy and later, after all resistances are worked through (both on the part of the
patient and of the analyst), he could continue with Internet therapy if this modality is
considered appropriate. In any case, a deep and prolonged analysis of all transference and
countertransference dynamics is indispensable before such decisions—just like for any
other decision, for that matter; for example, regarding the complex problem of the
termination of an analysis (or of many other problems that involve complex technical
decision and that are typical receptacles of defenses on the part both of the patient and the
therapist and of transferential and countertransferential issues, e.g., to name only one,
deciding whether to accept the patient’s request of inviting the spouse at a session in order
to discuss a specific problem). Especially countertransference should be carefully ana-
lyzed, not only because the choice of Internet therapy could stem from defensive reasons
on the part of the analyst (e.g., in order to avoid an emotional closeness with the patient
that the analyst sees— erroneously, as we have seen in our discussion—as related to
vis-à-vis therapy), but also because, conversely, the choice itself of preferring a tradi-
tional, “normal,” non-Internet therapy rather than an Internet therapy could be a counter-
transferential issue (e.g., in order to avoid specific emotions that the analyst sees—again,
erroneously—as related to Internet therapy, or due to his prejudice toward Internet, or to
his fantasies about Internet or the new technologies, and so on, in other words to his
“transference,” i.e., countertranference in the narrow sense).

Internet therapy can have its own dignity as a technique, exactly in the same way as
other techniques have their own dignity, techniques such as group therapy, family therapy
and so on. In fact, in these latter cases the question of which technique to choose and why
should always remain open (e.g., with a given patient should we recommend individual or
couple therapy?). What is important—in a truly psychoanalytic way of thinking—is not so
much our final decision, but the fact that the question remains open and that the
transference and countertransference dynamics of these preferences are continuously
analyzed. In a way, the choice made is less important than our continuous questioning as
to why we made this choice and not another one.

The theoretical and technical problems of Internet psychoanalysis are in many ways
identical to those of telephone analysis. This technique has now been practiced for decades
by many analysts, though for many years it was not so frequently discussed, or at least not
so frequently as it should have been, given the fact that it has been so widely used. (Often,
telephone calls to patients were described as “incidents” during a “normal” analysis). In
recent years, however, discussions of telephone analysis have become more open (see,
e.g., Hymer, 1984; Lindon, 1988; Sleek, 1997; Zalusky, 1998; Aronson, 2000; Lipton,
2001; Richards, 2001; Zarem, 2001; Leffert, 2003; Bassen, 2007; etc.), and a panel on
telephone analysis was held on August 1, 2009, at the 26th IPA Congress in Chicago,

293PSYCHOANALYSIS ON THE INTERNET

chaired by Charles Hanly and Horacio Etchegoyen, with papers by Jill Scharff, David
Scharff, Geoff Anderson, and Neville Symington.

Personally, I am convinced that the issue of telephone analysis was previously not so
widely discussed as it deserved because its theoretical examination could not have helped
but have important repercussions on the whole relationship between theory and technique
within “traditional” psychoanalysis. The tacit, unvoiced risk here was that a discussion of
telephone analysis would have amplified the momentum of a shift in the field in the
direction of the position taken, for example, by the late Gill (1984). The myth of technique
characterized by extrinsic criteria remained very reassuring for many analysts, especially
at a time when past theoretical certainties seemed to have led to a crisis and any number
of alternative theoretical models were appearing in the psychoanalytic marketplace. The
theoretical pole having been revealed as fragile, clinging to the technical pole was an
understandable inclination for analysts reacting to the threat of what they perceived as a
loss of identity (see Migone, 2000, pp. 229 –231). (I will not comment here on the wider
political and economic implications of the need to have a fixed procedure and setting for
the sake of a worldwide professionalization of psychoanalysis; these are easily under-
standable and not the subject of this paper.)

Internet psychotherapy could be considered on its own terms as a new frontier, in the
same way as in the history of psychoanalysis a “widening scope” (L. Stone, 1954) led
many analysts to face new technical problems that had the beneficial effect of forcing a
reformulation of theory. Think, for example, of the therapy of psychosis (Sullivan), of
children (Melanie Klein), of narcissism (Kohut), of borderline and severe personality
disorders (Kernberg and others), and also of adolescents, small and large groups, families,
addictions, delinquencies, and so forth. As we know, the exploration of these territories
produced a healthy rethinking of the classic theory of technique, one that in turn produced
generalized innovations that have enriched our understanding of curative factors.

What is important is not the fact that therapy is conducted with or without the Internet,
but the theory we use to justify it, including most especially our ability and commitment
to analyze the transferential and countertransferential reasons that lie behind the choice.
Has perhaps the patient, or the analyst, in their preference for Internet psychotherapy,
enacted a defense against some aspect of traditional therapy? And if this is the case, why?
Contrariwise, has the choice for traditional therapy been made by one of the two parties
or both as the expression of a resistance to an aspect of Internet psychotherapy that would
have been possible or useful to investigate? And so on. These considerations are not
specific to Internet therapy; they are the same choices as the ones we make for any
intervention or therapeutic modality whether individual, group, family, or couples therapy.
These choices, as well as their opposite, can be used as defensive receptacles, and it is the
careful analysis of the dynamics involved that constitutes the fulcrum of our work. There
is no place where we can rest psychoanalytically (for a more detailed discussion of these
problems, see Migone, 1994a, 1995, 2000, 2005, 2009, 2010, chap. 4). What I want to
emphasize is that we are not talking only of Internet therapy but of therapy tout court; that
is, of investigating the rationale behind any technical choice. It is only by clarifying the
theory of technique that is behind our choices that we can avoid being stuck in the blind
alleys of Technique with a capital “T” (i.e., a technique without a theory, or that has taken
the place of theory), and face, among other things, the technical issues of therapy with or
without the Internet.

I would like to make one final comment on the notion that a classic technique as
embodied in a particular set-up is apt to evoke the specific transferential or “regressive”
reactions that we want to analyze, because here once again there is an interesting parallel

294 MIGONE

with Internet psychoanalysis. We often hear that the Internet represents a particularly
charged setting for many subjects, more specifically that it evokes intense emotions and
regressive or “perverse” states. Think of erotic chat lines, or of the phenomenon of a
sudden and intense falling in love on the Internet, or of pedophilia, and so on. It seems that
the Internet is able to stir deep or repressed emotions, emotions that may, at times, be
paradoxically more intense than those evoked by normal, offline situations. Actually, in
my opinion, this may well be true for particular individuals but not for all, and it would
be a mistake to generalize these phenomena when they might only apply to a given society
or subculture. But let us assume that it is a more or less general phenomenon for the
purpose of argument. In that case, an argument could be made that this is precisely what
we want to have happen in the analysis, so we could analyze it. What I would like to point
out here is that this kind of logic is the same that is utilized in the case of classic
psychoanalytic technique, insofar as it is asserted in that connection that a particular set-up
(couch, rituals, the analyst as blank screen, Macalpine’s [1950] “infantile setting”) aims
at provoking the given behavior—transference—that we want to analyze. According to
this reasoning, classical psychoanalysis and Internet psychoanalysis would be to that
extent homologous. Indeed, once again, Internet therapy would seem to be a veritable
caricature of psychoanalysis with infantile transference being evoked in the latter and
perverse activity—with its characteristic transferences—in the former. These reactions
would equally be forms of presumed analytic “regression.”

As should be clear at this point, I disagree with this logic. In fact, in both cases the
mistake is to generalize to all subjects the effect that a given stimulus has on a particular
group of people. Moreover, even if this kind of reaction might in fact be generalizable
across different subjects, it is not clear why we would want to evoke this type of
transference and not another (see, in this regard, Gill’s [1984, pp. 168 –171] lucid critique
of the concept of regression in analysis). In other words, why shouldn’t we be just as
interested in evoking a transference that is different from the one evoked by classical
psychoanalysis— or for that matter by the Internet?

One final point in closing. This paper, as it has been emphasized, does not deal with
the differences between online and offline therapy per se, but on the theoretical implica-
tions of the way we think about a given therapeutic setting; in other words, it is a paper
on theory of psychoanalytic technique. However, a de-emphasis on the differences
between online and traditional therapy might overlook the fact that indeed there is a
difference, and this difference should be clearly spelled out, but again with a privileged
emphasis on the theoretical implication of this difference (and—as we’ll see— on its
philosophical implication, in a way): one aspect is undoubtedly absent in Internet therapy
but present in traditional therapy—the “physical” body of the patient. This absence can be
a fundamental problem for so-called body or movement therapies; that is, therapies that
use the patient’s body as such within therapy, and not just the patient’s fantasies and
emotions about his or her body. From this point of view, Internet therapy is surely
“inferior” to traditional therapy. But, if the considerations I have advanced in this paper
are cogent, then we cannot deny that traditional therapy, logically speaking, is itself
“inferior” to Internet psychotherapy— or to any other type of nontraditional therapy, for
that matter— because it is deprived of important data that can only be evoked with the sole
presence of a “virtual” body. “Virtual” reality and “real” reality (assuming that the latter
can be understood as such, a philosophically tricky proposition that cannot be discussed
here) are not superior one to the other, but simply two different kinds of experience. Each
one deserves to be investigated and respected; each one is able to give us precious
information on human nature.

295PSYCHOANALYSIS ON THE INTERNET

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299PSYCHOANALYSIS ON THE INTERNET

http://dx.doi.org/10.1016/j.chb.2008.05.011

http://dx.doi.org/10.1037/0736-9735.18.2.388

http://dx.doi.org/10.1111/j.1745-8315.2011.00548.x

http://dx.doi.org/10.1258/1357633011936633

http://dx.doi.org/10.1111/j.1745-8315.2010.00351.x

http://dx.doi.org/10.1177/000306515400200402

http://dx.doi.org/10.1111/1467-8721.01214

http://dx.doi.org/10.1017/CBO9780511581670

http://dx.doi.org/10.1037/a0023532

http://dx.doi.org/10.1177/00030651980460041601

Literature in psychotherapy differs from other areas of clinical practice. Generally, there are no clinical trials in psychotherapy because it is often neither appropriate nor ethical to have controls in psychotherapy research. This sometimes makes it more difficult to translate research findings into practice. In your role, however, you must be able to synthesize current literature and apply it to your own clients. For this Assignment, you begin practicing this skill by examining current literature on psychodynamic therapy and considering how it might translate into your own clinical practice.

Learning Objectives

Students will:

· Evaluate the application of current literature to clinical practice

To prepare:

· Review this week’s Learning Resources and reflect on the insights they provide.

Select ONE of the
Psychodynamic Therapy Articles
from the Learning Resources to evaluate for this Assignment.

Note: In nursing practice, it is not uncommon to review current literature and share findings with your colleagues. Approach this Assignment as though you were presenting the information to your colleagues.

The Assignment

In a 5- to 10-slide PowerPoint Presentation, address the following:

1-Provide an
Overview
of the article you selected.

2-What Population is under consideration?

3-What WAS the Specific Intervention that WAS used?

4-Is this a NEW Intervention or one that WAS already used?

5-What WERE the author’s claims?

6-Explain the Findings/Outcomes of the study in the article.

7- Include
Whether
this will translate into practice with your own clients. If so, How? If not, Why?

· 8-Explain Whether the limitations of the study might impact your ability to use the
Findings/Outcomes
presented in the article. Support your position with evidence-based literature.

Note:

The presentation should be 5–10 slides,
not including the title and reference slides. Include presenter notes (no more than ½ page per slide) and use tables and/or diagrams where appropriate. Be sure to support your work with specific citations from the article you selected. Support your approach with evidence-based literature.

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Areas of Expertise

Essay

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Book Review

Assignment

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Case Study

Letter

Article

Coursework

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Q & A

Critical Thinking

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