Sense of Possibility of becoming true

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Tele-analytic work has been spreading in the world. This setting challenges the traditional in-person analytic setting in many ways, encouraging us to explore many aspects of the analytic setting and process that we may take for granted. In this paper, I will describe the first meeting in shared physical space of an analytic couple after a long-term tele-analytic work so as to illustrate the clinical meaning of the patient’s sense of possibility of becoming true in her transferential phantasy. Meanwhile, the combination of in-person and tele-analytic work is also briefly discussed.
 
Clinical Background
Mrs. A is in her early thirties, married with a 5-year-old daughter. She is a teacher in a city in a European country, where she emigrated years ago. She has been in analysis with a male analyst for over 2 years, 2 sessions a week. It is an analytic work conducted purely through the Internet with videos. They had never met with each other before the work, and when Mrs A was introduced to the analyst, they had there first meeting online and continued their analytic work through the Internet from then on. In tele-analytic work, Mrs. A mainly talked about what happened in her life. She spoke with feelings connected to experiences in her childhood. She developed a positive transference towards her analyst. She trusted him, felt close, and was eager to hear how the analyst understood her. She felt supported and contained. At first, she didn’t want to have chance to meet the analyst in the shared physical space, but as she settled more and more into analytic work through the internet, she gradually felt and expressed her wish to meet the analyst one day in the shared physical analytic room. Sometimes, she had some sexual dreams in which she was physically very close to her analyst. Despite that, she couldn’t go deeper into exploration of her sexual transference.

Recently, Mrs. A went to the city where her analyst lives. Mrs. A would stay there for some days, and she clearly showed how she was eager to meet her analyst. They discussed about meeting in in-person analytic sessions there, and it would be the first time for both of them to be in a shared analytic physical space.
 
The meeting in the shared physical space for the first time
The analyst had told Mrs. A the time and the address for the session. When the session was coming, he waited for her to arrive. He was not so sure what she would look like in reality, whether she made him feel familiar or a little strange, and so on. He felt his wish to keep the continuity of their perception of each other from the past tele-analytic work, but now he felt a little uncertain about whether it could be done. 

Right on time, there was a knock on the door, the analyst came over and opened the door, finding Mrs. A standing there. Mrs. A wore leisure clothes, as if she would do some sports. She looked curiously at the analyst, as if wanting to identify that he was that analyst shown through the Internet. At the first sight of her, the analyst could feel something familiar but also something unfamiliar on her and between them, which aroused complex feelings in him at that moment. The analyst invited her to come into the room. Mrs. A walked around in the room a little to examine it. When the analyst invited her to sit down, she took the seat. Very quickly, she moved her body to and fro, and commented that the armchair was not as soft as she expected. Then she said, “You didn’t prepare well for me.” There was a tiny disappointment flashing by her face. Then she said she couldn’t enjoy the session because the analyst didn’t prepare a soft enough armchair for her. After a while, she said she had, before the session, wanted to test whether the analyst would provide her with a comfortable armchair. The analyst interpreted that she seemed trying to test his comfortable care for her in a physical way. She nodded, and said she always cared for herself by preparing a very comfortable armchair for herself in tele-analytic sessions at home, but in the first session when they met in the shared physical space, she wanted to feel cared for by the analyst.

From the start of the session, the analyst felt he paid much more attention to his posture and eyesight, etc. than he did in tele-analytic sessions. He clearly had a much stronger sense of the physical presence of both of them, and he felt the rich body language in communication. For instance, he could perceive many details of Mrs. A’s physical presentation, such as her vivid complexion, body movement, posture, etc, which vividly conveyed meaningful material to him for sensing and thinking. Meanwhile, the analyst could vividly feel that he was also fully exposed to Mrs. A in terms of his physical presence, all of which were quite different from those in the virtual space through the Internet. This difference did, as Mrs. A proved next, lead her to much deeper sexual transference.

In the session, Mrs. A had a free association about being pregnant. She said she had sex with her husband days before she came to see the analyst, and said she would have a pregnancy test after she came back. However, she said if the test would prove she was pregnant, she would not exactly know whether she had got pregnant before the session or after. The analyst was curious of why she put the session as the time coordinate of her pregnancy. Then he heard the patient continued saying with smiles that her friend who went out on business with her male boss and proved pregnant after coming back, and later, that friend was in a struggle in proving the pregnancy was related to the sex with her husband. The analyst tried to interpret that although it sounded that she was saying that she possibly got pregnant with her husband due to the sex with him before the session, there seemed to be a hidden phantasy that she could possibly have sex with the analyst in the session and would be pregnant in that way. Hearing that, she seemed not be able to understand what the analyst was saying and explained it would take time for pregnancy after sex with her husband and it might happen before, in or after the session. The analyst said to her that what he interpreted seemed to arouse her anxiety related to the phantasy of possible sex with the analyst in the session where they were both physically there, and said she might be seduced by the physical presence of the analyst in the shared physical space, meanwhile, she also might feel another possibility that her physical presence would seduce the analyst, through which they could possibly have sex leading to her pregnancy. She nodded and then told the analyst that she in fact had had a daydream in which they had sex in the room where they met for the first time. She said her sexual phantasy made her anxious, and she worried the analyst would be negatively influenced by her, for instance, she worried that the analyst couldn’t manage the analytic work as he could before, losing his analytic function, and meanwhile, she would be thought of by him as a patient with severe problems.
 
Discussion
Compared to in-person analytic work, tele-analytic work through the Internet has some limitations (Lin, 2015). It is very necessary for us to get to know the meaning of those limitations to analytic work without just criticizing them. In this paper, I described how the physical presence of both parties aroused an emotional storm (Bion, 1979) in, and even before, the first session within the shared physical space after their long-term pure tele-analytic work. The shift of the setting shows how a clear and vivid sense of connection emerged in both parties in terms of emotional link based on physical presence in the shared physical space. Mrs. A seemed to take advantage of the analyst’s physical presence beside her to test the analyst’s care for her in the shared physical space by checking whether the armchair in the analyst’s room was comfortable enough. That seems to indicate that she felt something missing in terms of feeling the analyst’s holding function in the past virtual tele-analytic space, the third space in-between her own physical space and the analyst’s. She had to prepare everything, like room, armchair, computer, etc, for herself. It stresses the fact that in in-person analytic work, the patient and the analyst can have a significant unity, which means not only the unity of mind and body of each party, but also the unity of both parties’ mind and body as a whole, realizing one of the sayings in Chinese philosophy “the unity of mind and body as a whole.” So, compared to tele-analytic work, in-person analytic work offers a whole situation, specifically in terms of their relational connection in which each party’s physical presence in front of the other holds clear and vivid psychological meaning. This leads to a whole sense of the situation including the unity of mind and body, of course also their shared physical space, as well as a more vivid sense of being in the here and now (King 1973) with the other. The clinical meaning of that was vividly manifested in Mrs A’s sexual phantasy about the analyst as well as the objective basis for that phantasy, i.e., their physical presence in shared physical space.

Mrs. A phantasized that she could be pregnant with the analyst in the first meeting in their shared physical space. Even though she could have had some sexual phantasies related to the analyst in tele-analytic work in the past, this one is quite different. In tele-analytic work, her sexual phantasy was more like just a phantasy, as she knew that the analyst would, in reality, never be able to penetrate into her body from far away through her computer screen; however, when they shared the same physical space, she had a sense of the possibility that the phantasy could become true as she got the physical basis for that. The content of the phantasy in this meeting was mainly about pregnancy with the analyst, which aroused, when it was opened up, her anxiety that the analyst would be damaged or she would be thought of as very severely disturbed patient. The first meeting with patient in shared physical space after a long-term tele-analytic work indicates a very key point about the meaning of traditional in-person analytic work, that is, when the patient developed her phantasy and transference toward the analyst, there is a sense of hidden possibility in her mind that the phantasy and wishes can become true, for instance, the sexual one. Those phantasies together with her sense of a hidden possibility of becoming true in the shared physical space can really make the phantasy and transference much more real, seductive and meanwhile threatening with emotional strain in valence, which, I think, is a very necessary part of natural development of the transference as well as the effective working on it.

Although tele-analytic work can do much for the patient, this case illustration reminds us of the fact that tele-analytic setting may detach some necessary link between mind and body as well as physical space, changing the intensity or even the quality of the transference, which might attenuate the productive analytic work.
It seems that, in order to compensate for it, tele-analytic work should be combined with regular in-person analytic work, so as to let the patient develop some necessary sense of possibility of becoming true in terms of her phantasy and wishes in the transference relationship, even though this possibility is put into the future in-person meeting when they are still in tele-analytic work. However, things are not as simple as just offering regular in-person analytic work along with tele-analytic work. For instance, the regular in-person analytic meeting may cause the patient to prefer in-person analytic work and even hope for it in tele-analytic sessions. The problem in such a case may be that what the patient desires for is the analyst in another time and space, rather than the analyst in here and now in virtual space. It may reach a level that the patient detaches herself from the relationship in here and now in tele-analytic session, which may hinder the work in tele-analytic sessions. In other cases, it can just be the opposite when the patient felt so pressurized in shared physical space that they would more like to meet the analyst in virtual space through internet, and in such cases, tele-analytic setting becomes a harbor for hiding, functioning like an externalized space for psychic retreat (Steiner, 1993). As a result, it is very necessary to understand the meaning of two kinds of settings for one specific patient and one treatment if combining in-person analytic work with tele-analytic work.

In brief, tele-analytic work is a new field, a field that needs more exploration and understanding.
 
 
Reference
 
Bion, W. R.(1979) Making the best of a bad job. In: Clinical Seminars and Other Works (pp. 321-331), ed. F.Bion. London: Karnac, 1994.
 
King, P. (1973) The therapist-patient relationship. Journal of Analytical Psychology. 18: 1-8
 
Lin, T. (2015) Teleanalysis: Problems and limitations. Chapter 9, Psychoanalysis Online 2: Impact on Development, Training, and Therapy. Edited by Jill Savege Scharff. (Will be published in 2015)
 
Steiner, J. (1993) Psychic Retreats: Pathological Organizations in Psychotic, Neurotic and Borderline Patients. London: Routledge.