Interesting description by Carole Rosen of an analysis that she conducted online using Skype. The analysis was conducted in Chinese with a patient in China, while Rosen was, I assume, located in New York and is not a native speaker of Chinese.
Rosen’s description of the clinical material is engaging and moving, but I was particularly interested in two aspects of her paper.
The first was the careful way in which she thought about the cultural framework of her Chinese patient. She describes both some general aspects of Chinese culture and also some specific issues faced by the generation that grew up during the Cultural Revolution. This understanding of her patient’s cultural and historical context was important in making sense of her patient’s inner world and in giving him the experience of being held in mind. It was also interesting to see how familiar themes, such as Oedipal relationships, were expressed within this cultural framework.
The second aspect of the paper that interested me was its description of communication across languages and across continents. Rosen was wary both of conducting the analysis in Chinese and of carrying it out over Skype. In both cases she seems to have established a good way of working with her patient, checking with him the meaning of unclear words and his preferred way of working at distance. She’s alert to the ways in which these issues are present within the transference and in themselves can provide useful avenues through which her patient’s phantasies can be explored.
Although I work solely in English, I’ve worked with many people who have English as a second language or who come from a very different culture to mine. In this work it’s been important to check our shared understanding of words. Even when working with someone whose first language is English, we can’t assume that we both mean the same thing by the same word. Being aware of and exploring different meanings is part of developing a shared understanding of each other and of building our relationship.
I’ve also worked via Skype and I agree that a therapeutic relationship can be developed in that way. It’s not the same as being in the room together, but a relationship can be built and change helped along.
via the website International Psychoanalysis