|
|
This is only a preview of the paper
Click here to register and get the full text.
Existing members click here to login
|
|
|
Online-psychotherapy and the question of ground rules
by
Dror Green
April 2001
INTRODUCTION: the cry for frame
In the beginning GOD created the BIT and the BYTE. ...
(Unknown online author)
In the chaos of the Web you can hear the cry for frame, as you can hear it everywhere else. ... Online humour, triggered by the fear of termination, is revealed by jokes about viruses. ...
Online frames give us a secure place to surf in, but we also need faith to support this process. An old Jewish prayer for travellers was adapted to the myth of the Internet, and I was wondering about its meaning when I received it by one of my online-clients:
May it be your will to cause us to connect in peace, to Web surf in peace and to reach the Web site of our desires in peace. ... Online-psychotherapy, which adopts the classical ground rules to the new space, supplies such a frame by creating a new kind of therapy.
Freud and the virtual couch: frame and transference
Psychoanalysis defines a set of ground rules for the therapeutic work. These rules provide us with some terms that enable us to start the therapeutic process, such as the couch, transference and counter-transference, neutrality and free associations. ...
I will argue that the new setting and frame of online-therapy provides the optimal condition to realise these ground rules. ... The very fact that these groups are held online can change the interactions. ... In online-therapy transference serves as a platform for the therapeutic relationship from the first step.
Online-psychotherapy provides the ultimate setting for neutrality and pure transference. I believe that Freud would be the first online-therapist, if he only could. Online-therapy is the natural upgrading to the therapeutic couch, as it creates what according to Freudian theory is the ideal conditions for the evocation of transference. ...
Online-therapy provides a secure space for free associating. ... Actually, in online-therapy the therapist cannot disturb clients’ free-associating, while putting them in written words.
Therapist’s response, on the screen, as any other online-stimulus (search engines, games, graphic devices) can be controlled by the client, and become part of his associative process.
The ground rules of psychotherapy, as defined by Langs (1998: 45), try to hide the therapists personality from the therapeutic scene. ...
(Freud, 1957: 331)
Online narratives: a scientific data
Psychotherapy is a virtual phenomenon. ...
I believe that online-psychotherapy opens a new era of psychotherapy, since it is based on a new kind of data, and opens this field to scientific research.
Many therapists resist the possibility of online-therapy. ... Online-therapy keeps every words that was ‘said’ by the therapist. ...
Online-psychotherapy does not reduce therapists’ activities, as these therapists claim, but open new horizons to the field of psychotherapy. ...
Before trying to adapt the traditional ground rules to online-therapy, we have to define the new setting and framework it is based on.
The new framework of online-therapy has nothing to do with the computer screen, which is part of the new setting. ... There are three main options for online-communication that can be used for online-therapy:
Chat rooms. These are virtual spaces where people can talk online with each other, in one-to-one session or groups. ... Actually, an online chat imitates a face-to-face conversation. ... Participants can ask a question or send a message to other participants and each message keeps it’s place in a catalogue tree. ...
These three options define the new framework to online-psychotherapy. ...
In online-psychotherapy clients’ narratives are the cores of the process. ...
Internet and ground rules: adaptation or new era
When you ask psychotherapists what psychotherapy is, you don’t expect to receive an answer. They will probably respond with a question, or do their best to avoid the subject. Some of them will be glad to tell you what sort of psychotherapy they do, but almost all of them will ignore the philosophical question, which is the basis for their profession. ... In a hundred years of psychotherapy no one asked the question ‘what is this psyche, that we are talking about? ... I believe that we are all aware of the ground rules for psychotherapy, which is the framework for any kind of therapeutic situation.
The term ‘ground rules’ refers to the main components of the psychotherapeutic procedure: frame, boundaries, setting, contract, the code of ethics and the theoretical and technical approaches. ‘Psychotherapeutic procedure’, in this context, is not a technical set of rules. ...
(Clarkson, 2000: viii)
Robert Langs put even more weight on the importance of ground rules in creating therapeutic relationship:
It has been clearly documented clinically that patients are exquisitely sensitive to the therapist’s management of these tenets. Because ground rules constitute the basic core of the therapeutic relationship. ...
(Langs, 1988: 26-27)
Although different approaches interpret the ground rules of psychotherapy in different ways, there is a convention about their role in the psychotherapeutic process. There are no definite ground rules universally accepted by psychotherapists, but there are some characteristics that play the same role in all psychotherapeutic approaches.
There are not many references to ‘ground-rules’ as a basic term in the psychotherapeutic literature, as to their separate components, such as ‘frame’ or ‘boundaries’. ...
Up to the end of the Twentieth century ground rules usually referred to face-to-face psychotherapy. The question of boundaries, frame, time, payment etc. ...
Is the therapeutic situation different in online-psychotherapy? ... This situation, as in face-to-face psychotherapy, becomes therapeutic when it is defined by a set of ground rules. If so, does it mean that we can adapt the ‘classical’ ground rules to online-therapy? ...
The use of the Internet as a new setting for the psychotherapeutic process is more than a technical change, and it requires a drastic adaptation of the ground rules to the new era.
The main innovation in online-psychotherapy is the isolation of the therapeutic situation from any other kind of human relationship (eye contact, etc. ...
These two new characteristics of online-therapy indicate a revolutionary deviation from classical psychotherapy. ... Here, we can adapt the classical ground rules of boundaries and confidentiality, with small adjustments that derive from the new technical devices (the use of passwords for security, for example).
The second needs new kind of ground rules, to fit the new qualities of the therapeutic narrative that serves as a scientific data. ... The new ground rules will have to relate to this data as a source for information, which have to be dealt in a new way. ...
Other classical ground rules need serious consideration in the process of adaptation to the new situation.
Online setting needs to be re-designed. ...
Although the chat room provides a situation almost similar to the face-to-face conversation, discussion groups and Emails change our understanding of time issues, and need special adaptation of the ground rules.
Online therapy raises the question of confidentiality and privacy, since technical protection can always be deciphered. ... Although online-psychotherapy can provide a better degree of confidentiality, I believe that its new devices will provoke a great deal of anxiety. Sometimes it work vice versa, and there is no question concerning confidentiality in open discussion groups, as I will describe here.
Therapeutic interventions play the same role in online-therapy, but their realisation is different. ...
Therapy: unconscious communication in written sessions
One of the claims against online-psychotherapy is that it lacks eye contact. This is true, and it can be regarded as the advantage of online-therapy. ...
In online-therapy we stay with pure narratives, which are not screened by external messages. ... In online-therapy it is easier to bracket our own associations and focus on the exact wording of our clients’ narratives.
There is not enough experience in online-therapy, and case studies and case example are still rare. It will be too pretentious and superficial to jump to conclusions in this stage, but it can be interesting and beneficial to bring some examples to the process of online-therapy. ... We didn’t have time to explore her feelings, and I offered her online therapy by weekly Email corresponding. ... It was my first experience with online-therapy, and the transfer from face-to-face therapy to online-therapy was very smooth. ... I was very surprised, because although this kind of group lacks some basic ground rules like confidentiality, privacy, time and space, still the therapeutic process proved to be very helpful. ... The structure of the group deviated from all ground rules, and it didn’t fit any of the classical demands for group psychotherapy (Yalom, 1995).
Approximate Word count = 7100
Approximate Pages = 28.4
(250 words per page double spaced)
|
|
|
|
|
|