Teleanalysis Does Not Have to be "Muted": On the Crucial Role of the Analyst's Internal Frame in any Setting.

Given that practicing teleanalytically is relatively new and more widespread than ever, questions about how to practice and teach it effectively have increased and are more pressing than ever. To contribute answers to these questions, this paper addresses long-standing and persisting negative views of teleanalysis as an inherently muted, remote, and pale experience with reduced therapeutic effectiveness. I propose that this view of teleanalysis as inherently inferior to in-office analysis limits or even precludes its therapeutic usefulness because it allows analysts to avoid making analytic use of the disturbing feelings hiding within the experience of practicing teleanalysis. Through case examples, I suggest that when analysts do not take our negative views of teleanalysis at face value but instead consider them as symbolic expressions of our and our patients' anxieties, we can improve our understanding of our analytic functioning within the tele-setting and enhance our capacity to think and engage analytically effectively in any setting. I maintain that these considerations have important implications, not only for how experienced analysts practice, but also for how we treat and teach future analysts.

Teleanalysis: Slippery Slope or Rich Opportunity?

In certain cases, and under certain conditions, extremely useful analytic work can be done on the phone or through videoconferencing. Contrary to what some critics of teleanalysis maintain, with patients who are motivated and can make use of analysis, physical distance between analyst and patient and/or occasional technological difficulties do not limit or preclude successful analysis. Clinical material from three teleanalyses demonstrates various conditions that help make teleanalysis useful. Instead of being a disadvantage, the juxtaposition of the experience of the "tele" and the in-person settings (in occasional in-person sessions) provides increased and unique opportunities for analysis.

Supervisory countertransferences and impingements in evaluating readiness for graduation: Always present, routinely under-recognized.

Utilizing detailed, in-depth material from supervisory hours from around the world (explored in End of Training Evaluation groups), this paper shows that supervisors are subject to multiple, diverse and, at times, ongoing intense countertransferences and impingements on their ability to evaluate candidates' progress. Multiple external and internal sources of these impingements are explored. It is suggested that supervisory countertransferences and their manifestation in parallel enactments remain under-recognized, their impact underappreciated, and the information they contain underutilized. It is argued that the recognition, containment, and effective use of the parallel process phenomena and supervisory countertransferences are essential in order to evaluate candidates' progression and readiness to graduate. Common signals of such entanglements in the supervisor's evaluative function are identified. Three remedies, each of which provides a 'third,' are offered to assist supervisors in making effective use of their countertransference: self-supervision, consultation, and institutional correctives.

Finding Control Cases and Maintaining Immersion: Challenges and Opportunities.

Given that surveys, as well as frequent observations by institute faculty, indicate that many candidates have difficulty finding control cases and maintaining immersion and that many graduate analysts face similar challenges, it would seem that psychoanalytic training does not prepare candidates adequately for finding patients and practicing analysis while in training and, for many, after they have graduated. Although external challenges are formidable, it is by identifying and making use of internal challenges to finding cases that candidates can develop an analytic mind: the identity, approach, and skills necessary not only to graduate but to have the choice to practice clinical psychoanalysis post-graduation. Some of the internal challenges and their manifestations in different phases of initiating analysis (referrals, initial consultation, recommendation) are discussed and two detailed examples are offered to illustrate the productive use of candidates' countertransferences in finding cases and maintaining immersion. Finally, recommendations for institutional solutions are provided.

Analysis begins in the analyst's mind: conceptual and technical considerations on recommending analysis.

For certain patients who approach analysts for treatment, analysis remains the only treatment that can provide the urgent and at times lifesaving help they need. At the same time, recommending analysis presents analysts with a surprisingly challenging emotional task. Because patients will not be able to get analytic help unless the analyst recommends it and facilitates the patient's engagement, it is vital that analysts identify the conditions that make the beginning of analysis possible. Analysis, it is argued, begins in the analyst's mind: how analysts think about their function, their patients, and the analytic process determines in great measure whether analysis will begin. Six essential components of the analyst's mindset are presented, as well as technical considerations about recommending analysis that are based on this mindset and that have been useful in initiating analysis. A detailed clinical example is provided to illustrate how the analyst's thinking informed the initial phase of a treatment with a patient who engaged in a productive analysis.

The analyst's ambivalence about continuing and deepening an analysis.

Of the many variables that affect an analyst's capacity to analyze, the analyst's ambivalence about analysis has received minimal attention. A previous paper (Ehrlich 2004) addressed how the analyst's ambivalence manifests itself in reluctance to recommend analysis and address the patient's resistances to the recommendation. The present paper examines the analyst's ambivalence about maintaining and deepening the analytic engagement. More specifically, it explores the analyst's conflicts around maintaining the analytic frame. A detailed clinical example illustrates how the analyst's continued scrutiny of her reluctance to maintain the analytic frame allowed a continuation of the analysis and a deepening of the analytic process. Given the current economic crisis and patients' increased propensity to use concerns about fee and frequency as a mode of resistance, it becomes increasingly important for analysts to recognize how their own ambivalence undermines their capacity to address those resistances effectively.

The analyst's reluctance to begin a new analysis.

Given the decline in the average psychoanalytic practice, it is crucial to examine the variables affecting the individual analyst's practice. One such variable is the analyst's reluctance to begin a new analysis. Literature exploring its origins, possible manifestations, and effects on the analyst's thinking and practicing is reviewed. The analyst's reluctance is considered (1) as a defense against powerful affects, (2) as a co-created resistance, and (3) as a manifestation of the analyst's conflicts. Two clinical examples illustrate how this reluctance and its subsequent recognition influence the analyst's work. It is suggested that the present reality of a socioeconomic climate adverse to psychoanalysis, with fewer patients willing to engage in analysis from the outset, might be used to rationalize the analyst's reluctance to begin. It is also suggested that the analyst's reluctance to begin a new analysis is much more pervasive and influential than is presently recognized.