As we continue to deal with our new normal during Covid-19, COPS study groups remain diligent in pursuing their missions. We moved our study group discussions online, and we learn from one another as we deal with the pandemic and our analytic work. In this issue, we feature Charles P. Fisher, chair of the Study Group on Psychoanalysis and Neuroscience, who discusses the relevance of neuroscience on our reactions and ways of coping during the pandemic. We welcome your feedback, comments, and participation in COPS.
Charles P. Fisher, Co-chair
The COPS Study Group on Psychoanalysis and Neuroscience was created in 2009 to develop educational materials and programs about the relationship between psychoanalysis and neuroscience for APsaA candidates, members, and institutes. Virginia Barry and I are the co-chairs.
In a time of rapid change in neuroscience and of theoretical pluralism within psychoanalysis, the work of our study group has turned to current controversies in both domains. In the light of the Covid crisis and the turn to distance analysis as a form of treatment practiced by most or all APsaA members, we are thinking about how neuroscientific considerations may inform us, the effects and significance of working with patients online, and how that interacts with analytic process.
Many psychoanalysts and psychotherapists describe unusual fatigue in working with patients through video technology. This phenomenon is not universal, however. Our study group is interested in why this phenomenon is so frequently reported, why it is not universal, and what it might imply about psychoanalytic and psychotherapeutic processes.
An article in the New York Times, “Why Zoom is Terrible,” by Kate Murphy (April 29, 2020) points out, “The problem is that the way the video images are digitally encoded and decoded, altered and adjusted, patched and synthesized introduces all kinds of artifacts: blocking, freezing, blurring, jerkiness, and out-of-sync audio. These disruptions, some below our conscious awareness, confound perception and scramble subtle social cues. Our brains strain to fill in the gaps and make sense of the disorder, which makes us feel vaguely disturbed, uneasy and tired without quite knowing why.”
A different spin is offered by Stephen Hartman, a psychoanalyst. In a widely circulated email, he wrote in response to Murphy's article: “It's not that the article is wrong about screen fatigue, etc. In fact, it could be much more descriptive about the neurocognitive differences between screen relations and in-person encounters. For that, I strongly recommend Gillian Russell's excellent 2015 book: Screen Relations: The Limits of Computer-Mediated Psychoanalysis and Psychotherapy. The problem with the article is that it works with a somewhat dubious premise that screen relations and in-person relations should be similar. Or, said differently, that screen relations are a second-rate version of the in-person relations that they mimic.”
His counsel is to “allow yourself to play with the differences between the two mediums rather than suffer the lack of verisimilitude,” and “imagine that digital time and space are a different kind of time and space with a different way of configuring experience.” In effect, Hartman supports video psychotherapy as a valid but fundamentally different form of treatment. Others believe that the video format is simply a different frame for treatment. Hartmann suggests it is fatiguing when we fight the difference.
The “Johnson” blog for The Economist (May 16-22, 2020) presents an article entitled “The Linguistic Psychology of ‘Zoom Fatigue.’” The author writes there is a lag of about 150 milliseconds – sometimes more – between the picture and the sound on Zoom and other platforms. That makes it difficult for speakers to time conversational turns with “no gap, no overlap.” Interruptions and pauses are more frequent, leading to difficulty in accurately assessing the intention of the speaker. For example, an additional pause due to the 150-millisecond lag time can make the speaker seem less convincing to the listener. (Daniel Foti and Felicia Roberts, “The neural dynamics of speech perception: Dissociable networks for processing linguistic content and
monitoring speaker turn-taking,” Brain & Language, 2016.)
An additional consideration is the difference between two-dimensional images on a screen and three-dimensional perception in face-to-face interaction. Erez Freud and Tzvi Ganel in “Visual control of action directed toward two-dimensional objects relies on holistic processing of object shape,” (Psychon Bull Rev 22, 2015) point out that two-dimensional and three-dimensional images are processed differently in the brain, requiring the mental construction of “perceptually driven holistic representations of object shape” in order to guide action. It is not clear from their experiments whether psychotherapy evokes the mental imagery of action on the part of the psychotherapist. What kind of reverie, mirror neuron activity, or imagined action takes place in the psychotherapist or psychoanalyst in the office or on the screen?
The natural experiment of teletherapy during the Covid crisis, combined with insights gained through neuroscience research, help us parse the internal psychic processes of psychoanalysts at work with patients in an office, on a video call, or on a telephone. In addition to helping us discern whether video-therapy is a distinctly different process from practice in an office, such experiments will support us in our efforts to describe the essential ingredients of a psychoanalytic frame.
[Editor's note: For more information on the sources in this article, please contact Charles P. Fisher at .]