What would Freud think of the virtual couch? From 1843mag
r Stephen Blumenthal normally takes a moment to gather his thoughts before inviting patients onto the blue leather couch in his consulting room in central London. Each consultation begins in the same way as it would have done a century ago when Sigmund Freud developed psychoanalysis. Patients are asked to say whatever comes into their heads.
Teletherapy makes that impossible. The analyst has no control over the patient’s environment on a video call, and can’t stop them being interrupted. Some patients have been retreating to their cars to guarantee them peace and quiet, says Blumenthal. Analysts too may have to allow patients a window into their own domestic lives. “At first it felt like an intrusion,” says Blumenthal. “My view now is that if you reveal nothing, the patient senses defensiveness and it can inhibit them.
There can also be unexpected advantages to the new medium, says Blumenthal. On the day that we spoke, he told me that he’d been forced to interrupt a teletherapy session on Zoom earlier that day in order to answer the persistent ringing of his doorbell. He left his microphone on while speaking to the courier, who had a package for his son.
Freud was not averse to innovation. He famously invited a patient he nicknamed the “Rat Man”, because of his obsessive thoughts about rats, to dine in his consulting room. But most of Freud’s devotees have treated his strictures as gospel and followed them like a religion. Some dared stray from the path: Sandor Ferenczi, a close contemporary of Freud, practised “self-disclosure” ; Jacques Lacan ended sessions at moments of emotional significance rather than after the usual 50 minutes.
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