During the hundred years in which psychoanalysis has developed, and especially during the last decade, there has been tremendous change in the nature of communications and the speed at which information is disseminated. Most of us tend to view these changes as positive. Freud blamed the telephone and the airplane for creating distance between family members. What would he have thought about the nature of jobs today, the amount of travel required, the changes effected in gender roles and family responsibilities, the nature of love relationships and the ways in which people meet and interact (the Internet, e-mail, cellular phones), the great emphasis on physical appearance, and the increased use of technology to change faces, bodies, and gender? These changes have affected the practice of psychoanalysis and psychotherapy in ways not yet fully understood or elucidated.
In the past decade, many individuals have managed to earn and accumulate great wealth in a short time, activating internal conflict about success and considerable envy and feelings of failure on the part of their not-so-successful peers. The very choice of psychoanalysis as a profession can involve abdicating the possibility of ever earning as much income as one's peers and choosing to become a lesser provider for one's family at a time when many feel entitled to expensive lifestyles.
These social changes influence who embarks upon a course of psychotherapy or psychoanalysis, how treatment is paid for, what fees can be charged, the frequency of visits, and the length of treatment itself. They affect what is spoken about and the form transferences and resistances take. Psychoanalytic technique has altered in informal and diverse ways, in part to deal with these changes, and these alterations are just beginning to find their way into the literature. The mass media (cable TV, the Internet, etc.) provide patient and analyst a wide range of shared information, influencing dreams and associations in ways that could not have been imagined by Freud in his time.
I have asked three members of our Association to write about aspects of social change affecting their practice. I will present some of my own experiences with patients who focus on appearance. Space limitations preclude a fuller discussion of these topics, as well as those of “telehealth,” “telesex,” and the like. This is just a beginning effort on the part of TAP to cover the broad topic of the impact of cultural change on patients and on psychoanalytic practice. TAP welcomes your thoughts and responses, as well as ideas for future articles on the subject.