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About three years ago, special circumstances led me to undertake psychotherapy by correspondence with a patient who was then hospitalized for tuberculosis. This is a report of the experience that followed.
The use of writing as a means of communication in psychotherapy is not without precedent. Freud's correspondence with Fliess, his written associations to his own dreams and acts, formed an important part of his self-analysis. Freud's Analysis of a Phobia in a Five Year Old Boy was in part carried out by correspondence with the boy's father. A similar method is reported by Leo Rangell in 'Treatment of Nightmares in a Seven Year Old Boy.' E. Pickworth Farrow, in his Psychoanalyze Yourself, describes his attempt at self-analysis, in which, like Freud, he wrote down and analysed his own free associations. Because of his deafness, David Farber's patients have written their associations instead of speaking them, and Farber reports on his observations in 'Written Communication in Psychotherapy'.
Grotjahn in his Gimbel Lectures describes an exchange of letters with an adolescent girl during a year's interruption of analysis which began after the 112th hour because of absences of both patient and analyst. The patient initiated the correspondence and it continued without specific prearrangement. In his commentaries to the correspondence, Grotjahn states, he attempted 'to gain time with the patient, to support and encourage her, to keep her going, and to stay in contact'. At the end of a year, the patient returned for two hundred additional analytic hours.
From this experience Grotjahn decided that 'such letters can serve the purpose of keeping contact with the patient, and perhaps if done properly can continue the patient in the process of working and living through'; that 'such correspondence is limited in its usefulness, but has made it easier for my former patient to return later in treatment'. He believes that 'the letters did not play a great part